=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881739522
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAMELA DENISE SPEARS PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2020 NE 163 STREET SUITE 300
-----------------------------------------------------
City | NORTH MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33162
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-949-1515
-----------------------------------------------------
Fax | 305-949-1518
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2020 NE 163 STREET SUITE 300
-----------------------------------------------------
City | NORTH MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33162
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-949-1515
-----------------------------------------------------
Fax | 305-949-1518
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MH6625
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------