Healthcare Provider Details

I. General information

NPI: 1083261200
Provider Name (Legal Business Name): PAMELA THOMPSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2019
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 GREAT AMERICA PKWY
SANTA CLARA CA
95054-1122
US

IV. Provider business mailing address

5201 GREAT AMERICA PKWY
SANTA CLARA CA
95054-1122
US

V. Phone/Fax

Practice location:
  • Phone: 831-431-0647
  • Fax:
Mailing address:
  • Phone: 831-431-0647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701008478
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number07008478
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: