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General NPI Number Information
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NPI Number | 1356071138
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Entity Type | Organization
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Legal Business Name | PAMELA ANDERSON LICENSED MARRIAGE AND FAMILY THERAPIST INC
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Dates
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Enumeration Date | 06/14/2022
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Last Update Date | 06/14/2022
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Provider Practice Location Address
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Address Line | 18229 MILMORE AVE
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City | CARSON
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State | CA
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Zip | 90746-1751
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Country | US
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Telephone | 310-629-1183
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Fax |
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Provider Business Mailing Address
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Address Line | 18229 MILMORE AVE
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City | CARSON
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State | CA
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Zip | 90746-1751
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PAMELA ANDERSON
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Credential |
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Telephone | 310-629-1183
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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 |
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License Number State |
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