Provider Demographics
NPI:1669179768
Name:COOK, PAMELA LYNN (MA, LPC, NCC)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:LYNN
Last Name:COOK
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:HECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:CO
Mailing Address - Zip Code:81069-0337
Mailing Address - Country:US
Mailing Address - Phone:480-406-8982
Mailing Address - Fax:
Practice Address - Street 1:4490 BENT BROTHERS BLVD STE D1
Practice Address - Street 2:
Practice Address - City:COLORADO CITY
Practice Address - State:CO
Practice Address - Zip Code:81019-9990
Practice Address - Country:US
Practice Address - Phone:719-250-6562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0018062101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional