Provider Demographics
NPI:1780064436
Name:MANSOUR, PAMELA (LPCC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:MANSOUR
Suffix:
Gender:F
Credentials:LPCC
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 645
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:OH
Mailing Address - Zip Code:44202-0645
Mailing Address - Country:US
Mailing Address - Phone:330-906-2123
Mailing Address - Fax:330-666-5001
Practice Address - Street 1:3610 W MARKET ST STE 102
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-9301
Practice Address - Country:US
Practice Address - Phone:330-906-2123
Practice Address - Fax:330-666-5001
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE1700066101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional