Provider Demographics
NPI:1366801847
Name:PAMELA SCHUTTER
Entity type:Organization
Organization Name:PAMELA SCHUTTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:940-484-2158
Mailing Address - Street 1:475 W TOWN PL
Mailing Address - Street 2:SUITE 205 D
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3648
Mailing Address - Country:US
Mailing Address - Phone:904-484-2158
Mailing Address - Fax:
Practice Address - Street 1:475 W TOWN PL
Practice Address - Street 2:SUITE 205 D
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-3648
Practice Address - Country:US
Practice Address - Phone:904-484-2158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty