Provider Demographics
NPI:1780367698
Name:WARREN, PAMELA (LPC)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:
Last Name:WARREN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2088 WILLOW TRL
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-4423
Mailing Address - Country:US
Mailing Address - Phone:636-699-8976
Mailing Address - Fax:
Practice Address - Street 1:923 E TERRA LN
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-2726
Practice Address - Country:US
Practice Address - Phone:636-395-8021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021004941101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO47-5459037OtherGENERATIONS COUNSELING