Provider Demographics
NPI:1780997544
Name:COUNCELL, PAMELA KAY (CADCIII, QMHP, CSWA)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:KAY
Last Name:COUNCELL
Suffix:
Gender:F
Credentials:CADCIII, QMHP, CSWA
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:KAY
Other - Last Name:DANIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CADC 1, QMHP
Mailing Address - Street 1:58147 COLUMBIA RIVER HWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-6226
Mailing Address - Country:US
Mailing Address - Phone:503-396-5322
Mailing Address - Fax:
Practice Address - Street 1:58147 COLUMBIA RIVER HWY
Practice Address - Street 2:SUITE C
Practice Address - City:SAINT HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-6226
Practice Address - Country:US
Practice Address - Phone:503-396-5322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 171M00000X
OR11-06-18101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator