Provider Demographics
NPI:1740732270
Name:SEVERSON, PAMELA JEAN (LMHC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEAN
Last Name:SEVERSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:JEAN
Other - Last Name:BOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1350 BOYSON RD STE D2
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-2211
Mailing Address - Country:US
Mailing Address - Phone:319-440-7317
Mailing Address - Fax:319-423-6123
Practice Address - Street 1:1350 BOYSON RD STE D2
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233
Practice Address - Country:US
Practice Address - Phone:319-596-6800
Practice Address - Fax:319-423-6123
Is Sole Proprietor?:No
Enumeration Date:2016-11-01
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA078850101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health