Individual provider Active NPI

Pamela Wharton, LPC

  • Professional Counselor
  • Bolivar, MO
National Provider Identifier
1083047690
Registry record updated Aug 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
2012038134 Issued in MO
Practice address
315 S Main Ave
Bolivar, MO 65613-2052
Phone
(417) 326-2902
Fax
(417) 326-4555
NPI assigned
Aug 19, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 2012038134 MO Primary

Addresses

Primary practice location

315 S Main Ave
Bolivar, MO 65613-2052

Mailing address

315 S Main Ave
Bolivar, MO 65613-2052
Phone (417) 326-2902

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240311002384 MO Practitioner - Mental Health Counselor 3577909795 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2012038134MOMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Pamela J Wharton, LLC Professional CurrentSince Oct 7, 2014 Accepting new patients

Locations

3897 N 20th St
Ste 1
Ozark, MO 65721
Phone (417) 770-2901

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1376870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376870400000",
    "number": "1083047690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 S MAIN AVE",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656132052",
            "telephone_number": "417-326-2902",
            "fax_number": "417-326-4555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 S MAIN AVE",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656132052",
            "telephone_number": "417-326-2902",
            "fax_number": "417-326-4555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHARTON",
        "first_name": "PAMELA",
        "name_prefix": "Ms.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-19",
        "last_updated": "2013-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MO",
            "license": "2012038134",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bolivar, MO

Sources for this page

Verify at the official NPI Registry.