MEDICARE: MS. PAMELA KAY LAURIE

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	106H00000X	Marriage & Family Therapist	IMF 55198	CA

General Provider Information

NPI Number	:	1356548887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAMELA KAY LAURIE

Provider Business Mailing Address
First Line	:	3805 CARSON RD
Second Line	:
City	:	CAMINO
State	:	CA
Zip	:	95709-9307
Country	:	US
Telephone Number	:	530-647-2994
Fax Number	:

Provider Business Practice Location Address
First Line	:	3805 CARSON RD
Second Line	:
City	:	CAMINO
State	:	CA
Zip	:	95709-9307
Country	:	US
Telephone Number	:	530-647-2994
Fax Number	:

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

Provider Enumeration Date	:	06/28/2007
Last Update Date	:	08/17/2011

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