Provider Demographics
NPI:1124234893
Name:HENDRICKSON, PAMELA J (LPC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:J
Other - Last Name:HENDRICKSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:623 DAHL RD
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-2782
Mailing Address - Country:US
Mailing Address - Phone:605-920-0365
Mailing Address - Fax:
Practice Address - Street 1:623 DAHL RD
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783
Practice Address - Country:US
Practice Address - Phone:605-642-2777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1097101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health