Provider Demographics
NPI:1447483896
Name:SLATER, PAMELA G (LCSW)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:G
Last Name:SLATER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 MAGNOLIA RD
Mailing Address - Street 2:
Mailing Address - City:NEWKIRK
Mailing Address - State:NM
Mailing Address - Zip Code:88431-9001
Mailing Address - Country:US
Mailing Address - Phone:575-799-1691
Mailing Address - Fax:
Practice Address - Street 1:214 E MAIN ST
Practice Address - Street 2:
Practice Address - City:TUCUMCARI
Practice Address - State:NM
Practice Address - Zip Code:88401-2223
Practice Address - Country:US
Practice Address - Phone:575-799-1691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2022-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-081181041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical