Provider Demographics
NPI:1366539819
Name:GRASSBAUGH, PAMELA JANE (LPCC, LADAC)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:JANE
Last Name:GRASSBAUGH
Suffix:
Gender:F
Credentials:LPCC, LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 S. SOLANO
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001
Mailing Address - Country:US
Mailing Address - Phone:575-527-7900
Mailing Address - Fax:575-571-4872
Practice Address - Street 1:1720 E. 32ND ST.
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061
Practice Address - Country:US
Practice Address - Phone:505-388-2693
Practice Address - Fax:575-534-0120
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0145801101YP2500X
NM0117671101YA0400X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM18677037Medicaid
NM54788854Medicaid