Provider Demographics
NPI:1316348949
Name:HUMFLEET, PAMELA DAWN (MED, LPCC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:DAWN
Last Name:HUMFLEET
Suffix:
Gender:F
Credentials:MED, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 N. DIXIE HWY.
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701
Mailing Address - Country:US
Mailing Address - Phone:270-505-4183
Mailing Address - Fax:270-900-1238
Practice Address - Street 1:4000 N DIXIE HWY STE 4
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701
Practice Address - Country:US
Practice Address - Phone:270-505-4183
Practice Address - Fax:270-900-1238
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYLPCCCA00195384101YM0800X
KY172042101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health