Healthcare Provider Details

I. General information

NPI: 1447557954
Provider Name (Legal Business Name): PAMELA M. NILSSON, PH.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2011
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23811 CHAGRIN BLVD STE 248
BEACHWOOD OH
44122-5560
US

IV. Provider business mailing address

23811 CHAGRIN BLVD STE 248
BEACHWOOD OH
44122-5560
US

V. Phone/Fax

Practice location:
  • Phone: 216-789-3878
  • Fax: 216-920-6288
Mailing address:
  • Phone: 216-299-6843
  • Fax: 216-920-6288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number6455
License Number StateOH

VIII. Authorized Official

Name: DR. PAMELA M. NILSSON
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PH.D.
Phone: 216-789-3878