Provider Demographics
NPI:1659452217
Name:SCHACKEL, PAMELA K (LISW, LPCC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:K
Last Name:SCHACKEL
Suffix:
Gender:F
Credentials:LISW, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1533 S SAINT FRANCIS DR STE E
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4032
Mailing Address - Country:US
Mailing Address - Phone:505-988-4131
Mailing Address - Fax:505-992-6145
Practice Address - Street 1:1533 S SAINT FRANCIS DR STE E
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4032
Practice Address - Country:US
Practice Address - Phone:505-988-4131
Practice Address - Fax:505-992-6145
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-33381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM0281OtherLPCC
NMA 1096 NMMedicaid