Provider Demographics
NPI:1750563441
Name:IVERSON, PAMELA THEREASE I (LPC, CACIII, EMDRII)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:THEREASE
Last Name:IVERSON
Suffix:I
Gender:F
Credentials:LPC, CACIII, EMDRII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:749 S LEMAY 3A PMB 412
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524
Mailing Address - Country:US
Mailing Address - Phone:970-223-2955
Mailing Address - Fax:970-204-1583
Practice Address - Street 1:344 E FOOTHILLS PKWY
Practice Address - Street 2:SUITE 8E
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2662
Practice Address - Country:US
Practice Address - Phone:970-223-2955
Practice Address - Fax:970-204-1583
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCR6271101YA0400X
COLPC 4043101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)