Provider Demographics
NPI:1487107512
Name:PANTER, ADRIENNE (PSYD, LPC)
Entity type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:
Last Name:PANTER
Suffix:
Gender:F
Credentials:PSYD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:PAGOSA SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81147-0608
Mailing Address - Country:US
Mailing Address - Phone:970-946-8123
Mailing Address - Fax:
Practice Address - Street 1:1032 1/2 MAIN AVE
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5124
Practice Address - Country:US
Practice Address - Phone:970-946-8123
Practice Address - Fax:970-764-4592
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-25
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0012827101YM0800X, 101YP2500X
COPSY.0005030103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional