NPI |
1396236246 |
The country code in the location address of the provider being identified. |
Entity Type Code |
2 |
The telephone number associated with the location address of the provider being identified. |
Employer Identification Number EIN |
|
The fax number associated with the location
address of the provider being identified. |
Provider Organization Name Legal Business Name |
PAMELA ANDERSON LCSW LLC |
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider First Line Business Practice Location Address |
2501 BLICHMAN AVE STE 117 |
The date that a record was last updated or changed. |
Provider Business Practice Location Address City Name |
GRAND JUNCTION |
The code designating the provider’s gender if the provider is a person. |
Provider Business Practice Location Address State Name |
CO |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider Business Practice Location Address Postal Code |
815051031 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Provider Business Practice Location Address Telephone Number |
9706442950 |
|
Provider Enumeration Date |
5/27/2018 |
|
Last Update Date |
10/18/2018 |
|
Authorized Official Last Name |
SNYDER |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
Authorized Official First Name |
MELENIE |
|
Authorized Official Title or Position |
BILLING AGENT |
The title or position of the authorized official. |
Authorized Official Telephone Number |
9706284562 |
The 10-position telephone number of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
1041C0700X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider License Number 1 |
00000661 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Provider License Number State Code 1 |
CO |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Organization Subpart |
N |
|
Healthcare Provider Taxonomy Group 1 |
193400000X SINGLE SPECIALTY GROUP |
|