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Individual

PAMELA SUE WISE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LPC,CPC

Contact information

Practice address
4385 OAKES MILL CT, CASTLE ROCK, CO 80109-7985
(580) 445-8643
Mailing address
4385 OAKES MILL CT, CASTLE ROCK, CO 80109-7985
(580) 445-8643

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
1205
OK
101Y00000X
Counselor
Primary
CP0221
NV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
04291953
BIRTHDATE
Enumeration date
01/10/2020
Last updated
01/10/2020
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