Provider Demographics
NPI:1841357258
Name:MUNSON, PAMELA S (MA LCPC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:S
Last Name:MUNSON
Suffix:
Gender:F
Credentials:MA LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3145 EAST 2780 NORTH ROAD
Mailing Address - Street 2:
Mailing Address - City:DONOVAN
Mailing Address - State:IL
Mailing Address - Zip Code:60931-8018
Mailing Address - Country:US
Mailing Address - Phone:815-486-7482
Mailing Address - Fax:815-486-7482
Practice Address - Street 1:197 W HARRISON ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1958
Practice Address - Country:US
Practice Address - Phone:815-802-0479
Practice Address - Fax:815-802-0479
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional