Provider Demographics
NPI:1265782924
Name:ANDERSON, PAMELA P (MA COUN, LCPC)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:P
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MA COUN, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 S VISTA AVE # 287
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-2429
Mailing Address - Country:US
Mailing Address - Phone:208-830-0601
Mailing Address - Fax:
Practice Address - Street 1:4346 W ROSE HILL ST STE A
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-5193
Practice Address - Country:US
Practice Address - Phone:208-830-0601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-10
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-C6682101YM0800X
IDLPC-5003101YM0800X
IDLCPC-6682101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health