Provider Demographics
NPI:1124177803
Name:FALER, PAMELA KAY (LMFT)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:KAY
Last Name:FALER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 BURNSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-3303
Mailing Address - Country:US
Mailing Address - Phone:801-273-7480
Mailing Address - Fax:
Practice Address - Street 1:2055 BURNSIDE CIR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-3303
Practice Address - Country:US
Practice Address - Phone:801-273-7480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT115537-3902101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health