Provider Demographics
NPI:1154528529
Name:HARTMAN, PAMELA JO (DMIN, LPC)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:JO
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:DMIN, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 132
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NM
Mailing Address - Zip Code:88318-0132
Mailing Address - Country:US
Mailing Address - Phone:505-849-2924
Mailing Address - Fax:
Practice Address - Street 1:903C 5TH ST.
Practice Address - Street 2:
Practice Address - City:ESTANCIA
Practice Address - State:NM
Practice Address - Zip Code:87016-0807
Practice Address - Country:US
Practice Address - Phone:505-384-2777
Practice Address - Fax:505-384-2204
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0090511101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM0090511OtherLPC