Provider Demographics
NPI:1801531280
Name:DRISCOLL, PAMELA K (MA, LAMFT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:K
Last Name:DRISCOLL
Suffix:
Gender:F
Credentials:MA, LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N 23RD ST STE 106
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-4969
Mailing Address - Country:US
Mailing Address - Phone:208-225-5802
Mailing Address - Fax:
Practice Address - Street 1:200 N 23RD ST STE 106
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4969
Practice Address - Country:US
Practice Address - Phone:208-225-5802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-01
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLAMFT-9145106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist