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General NPI Number Information
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NPI Number | 1053571950
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Entity Type | Individual
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Provider Name | PAMELA LYNN GEORGETTE LMFT
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Gender | Female
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Dates
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Enumeration Date | 06/13/2008
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Last Update Date | 01/12/2023
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Provider Practice Location Address
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Address Line | 12725 VENTURA BLVD STE G
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City | STUDIO CITY
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State | CA
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Zip | 91604-2437
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Country | US
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Telephone | 818-813-1621
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Fax |
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Provider Business Mailing Address
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Address Line | 3435 OCEAN PARK BLVD # 107-3
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City | SANTA MONICA
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State | CA
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Zip | 90405-3301
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Country | US
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Telephone | 818-813-1621
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 49940
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC 49929
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License Number State | CA
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