Healthcare Provider Details

I. General information

NPI: 1831236918
Provider Name (Legal Business Name): PAM THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 04/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 W CENTINELA AVE SUITE 150
CULVER CITY CA
90230-6337
US

IV. Provider business mailing address

6101 W CENTINELA AVE SUITE 150
CULVER CITY CA
90230-6337
US

V. Phone/Fax

Practice location:
  • Phone: 310-988-1970
  • Fax:
Mailing address:
  • Phone: 310-988-1970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY8367
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: