Provider Demographics
NPI:1750534392
Name:ROBERTS, PAMELA S (MDIV)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:S
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 788
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80901-0788
Mailing Address - Country:US
Mailing Address - Phone:719-471-2500
Mailing Address - Fax:
Practice Address - Street 1:420 N NEVADA AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1227
Practice Address - Country:US
Practice Address - Phone:719-471-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral