Provider Demographics
NPI:1740808914
Name:WEISMAN, PAMELA (MA, LPCC, CACII)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:WEISMAN
Suffix:
Gender:F
Credentials:MA, LPCC, CACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2457 LARK DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1863
Mailing Address - Country:US
Mailing Address - Phone:573-999-9427
Mailing Address - Fax:
Practice Address - Street 1:125 N PARKSIDE DR STE 202
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-6097
Practice Address - Country:US
Practice Address - Phone:719-428-5432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0017072101YM0800X
COACB.0008662101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health