Provider Demographics
NPI:1669959078
Name:GANEM, PAMELA MICHELLE (MS COUNSELING)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:MICHELLE
Last Name:GANEM
Suffix:
Gender:F
Credentials:MS COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1785 NE SANDY BLVD STE 270
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2791
Mailing Address - Country:US
Mailing Address - Phone:503-622-8964
Mailing Address - Fax:503-715-5469
Practice Address - Street 1:4141 N WILLIAMS AVE STE 106
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-2991
Practice Address - Country:US
Practice Address - Phone:971-402-0083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-27
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling