Provider Demographics
NPI:1326412362
Name:GRABER, PAMELA LYNN (LMFT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:LYNN
Last Name:GRABER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8154 ENCLAVE RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-3032
Mailing Address - Country:US
Mailing Address - Phone:612-590-4440
Mailing Address - Fax:
Practice Address - Street 1:8154 ENCLAVE RD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-3032
Practice Address - Country:US
Practice Address - Phone:612-590-4440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2672106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist