Provider Demographics
NPI:1154335628
Name:STANLEY, PAMELA J (LPCC, ACT)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:J
Last Name:STANLEY
Suffix:
Gender:F
Credentials:LPCC, ACT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 BRADBURY DR SE
Mailing Address - Street 2:SUITE 2222
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4374
Mailing Address - Country:US
Mailing Address - Phone:505-272-8950
Mailing Address - Fax:505-272-8060
Practice Address - Street 1:933 BRADBURY DR SE
Practice Address - Street 2:SUITE 2222
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4374
Practice Address - Country:US
Practice Address - Phone:505-272-8950
Practice Address - Fax:505-272-8060
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0096031101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
11584170OtherCAQH
7838830OtherAETNA
NM00JN70OtherBCBS
202000137OtherPRESBYTERIAN