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General NPI Number Information
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NPI Number | 1790842458
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Entity Type | Organization
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Legal Business Name | PAMELA W LINNELL PH D P C
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 05/27/2008
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Provider Practice Location Address
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Address Line | 400 N PENNSYLVANIA AVE SUITE #1080
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City | ROSWELL
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State | NM
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Zip | 88201-4754
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Country | US
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Telephone | 505-622-4519
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Fax |
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Provider Business Mailing Address
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Address Line | 400 N PENNSYLVANIA AVE SUITE #1080
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City | ROSWELL
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State | NM
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Zip | 88201-4754
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Country | US
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Telephone | 505-622-4519
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PAMELA W LINNELL
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Credential | PH.D.
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Telephone | 505-622-4519
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 759
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License Number State | NM
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