Provider Demographics
NPI:1770715179
Name:GOLDBERG, PAMELA M (LMFT)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:M
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6284 S RAINBOW BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-3244
Mailing Address - Country:US
Mailing Address - Phone:702-257-0140
Mailing Address - Fax:702-257-0139
Practice Address - Street 1:6284 S RAINBOW BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-3244
Practice Address - Country:US
Practice Address - Phone:702-257-0140
Practice Address - Fax:702-257-0139
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLMFT07777106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVLMFT0777OtherNEVADA STATE BOARD OF MARRIAGE AND FAMILY THERAPISTS