Provider Demographics
NPI:1265416820
Name:KURTHY, PAMELA ELIN (LICSW ACSW)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:ELIN
Last Name:KURTHY
Suffix:
Gender:F
Credentials:LICSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 ALMA DR
Mailing Address - Street 2:
Mailing Address - City:KELSO
Mailing Address - State:WA
Mailing Address - Zip Code:98626-3226
Mailing Address - Country:US
Mailing Address - Phone:360-577-6559
Mailing Address - Fax:
Practice Address - Street 1:1339 COMMERCE AVE
Practice Address - Street 2:STE 310D
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3738
Practice Address - Country:US
Practice Address - Phone:360-577-6559
Practice Address - Fax:360-425-1940
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW00005251103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist