Healthcare Provider Details

I. General information

NPI: 1528189883
Provider Name (Legal Business Name): PAMELA J. MCLEOD MA, MFTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11716 ENTERPRISE DR
AUBURN CA
95603-3732
US

IV. Provider business mailing address

175 LIVERMORE WAY
FOLSOM CA
95630-5217
US

V. Phone/Fax

Practice location:
  • Phone: 530-889-6700
  • Fax:
Mailing address:
  • Phone: 916-983-4086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: