Provider Demographics
NPI:1871529685
Name:BARICKMAN, PAMELA A SR (LPC-MH)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:A
Last Name:BARICKMAN
Suffix:SR
Gender:F
Credentials:LPC-MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 SOUTH ST.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701
Mailing Address - Country:US
Mailing Address - Phone:605-391-3482
Mailing Address - Fax:605-342-8144
Practice Address - Street 1:809 SOUTH ST.
Practice Address - Street 2:SUITE 201
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701
Practice Address - Country:US
Practice Address - Phone:605-391-3482
Practice Address - Fax:605-342-8144
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC-MH2104101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD264181507OtherTAX ID #
SD6575760Medicaid