MEDICARE: PAMELA S BERRYMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1356047013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA S BERRYMAN

Provider Business Mailing Address
First Line	:	7214 COUNTY FARM RD
Second Line	:
City	:	LEXINGTON
State	:	MI
Zip	:	48450-9552
Country	:	US
Telephone Number	:	810-841-5390
Fax Number	:

Provider Business Practice Location Address
First Line	:	7214 COUNTY FARM RD
Second Line	:
City	:	LEXINGTON
State	:	MI
Zip	:	48450-9552
Country	:	US
Telephone Number	:	810-841-5390
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2023
Last Update Date	:	02/03/2023

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Directions to “ PAMELA S BERRYMAN ” Practice Location

Language	Start Address	Practice Location

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