MEDICARE: MS. PAMELA SHIPLEY MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MR19760	CA

General Provider Information

NPI Number	:	1134337967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAMELA SHIPLEY MFT

Provider Business Mailing Address
First Line	:	250 ELK ST
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95065-1300
Country	:	US
Telephone Number	:	831-426-1470
Fax Number	:

Provider Business Practice Location Address
First Line	:	710 RIVER ST
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-2748
Country	:	US
Telephone Number	:	831-423-4566
Fax Number	:	831-423-4566

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/08/2007

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