Provider Demographics
NPI:1114006285
Name:ROSKELLEY-JOHNSON, PAMALA DIANE (LPC)
Entity type:Individual
Prefix:MRS
First Name:PAMALA
Middle Name:DIANE
Last Name:ROSKELLEY-JOHNSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-2536
Mailing Address - Country:US
Mailing Address - Phone:801-808-1616
Mailing Address - Fax:801-486-1113
Practice Address - Street 1:150 S 600 E
Practice Address - Street 2:SUITE 1C
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1999
Practice Address - Country:US
Practice Address - Phone:801-808-1616
Practice Address - Fax:801-486-1113
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT367557-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional