=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730190414
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAM E LUSCHEI MFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2006
-----------------------------------------------------
Last Update Date | 01/12/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7777 ALVARADO RD SUITE 273
-----------------------------------------------------
City | LA MESA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91941-3616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-460-8500
-----------------------------------------------------
Fax | 619-460-8502
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7777 ALVARADO RD SUITE 273
-----------------------------------------------------
City | LA MESA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91941-3616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-460-8500
-----------------------------------------------------
Fax | 619-460-8502
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFT 37185
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------