Provider Demographics
NPI:1992812630
Name:MUNSON, PAMELA KAYE (LPC)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:KAYE
Last Name:MUNSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66354 440TH ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:MN
Mailing Address - Zip Code:55332-3017
Mailing Address - Country:US
Mailing Address - Phone:507-426-6117
Mailing Address - Fax:
Practice Address - Street 1:66354 440TH ST
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:MN
Practice Address - Zip Code:55332-3017
Practice Address - Country:US
Practice Address - Phone:507-426-6117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00211101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN101Y00000XOtherLPC