Provider Demographics
NPI:1154626158
Name:MCCRACKEN, PAMELA S (LCSW, MAC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:S
Last Name:MCCRACKEN
Suffix:
Gender:F
Credentials:LCSW, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 W MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-3520
Mailing Address - Country:US
Mailing Address - Phone:970-217-8183
Mailing Address - Fax:
Practice Address - Street 1:151 W LAKE STREET
Practice Address - Street 2:COLORADO STATE UNIVERSITY HEALTH NETWORK
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524
Practice Address - Country:US
Practice Address - Phone:970-491-0262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO507947101YA0400X
101YM0800X
CO099236321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health