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MRS. PAMELA GAYLE LEISURE CCDC III

Addiction Substance Use Disorder

Watertown, South Dakota

Provider NPI: 1356337760

Provider Information:
MRS. PAMELA GAYLE LEISURE CCDC III
Gender: F


Practice Location:
123 19TH ST NE  WATERTOWN, SD 57201 US
Tel: 605-886-0123  Fax: 605-886-5447

Business Mailing Address:
PO BOX 1030  WATERTOWN, SD 57201 US
Tel: 605-886-0123  Fax: 605-886-5447

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y101YA0400XBehavioral Health & Social Service Providers
Counselor
Addiction (Substance Use Disorder)
SD03071158

Other Provider Identifiers:

IssuerNumberStateType
ICADC2359301
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







ADDICTION JOBS SD - Page 1



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