MEDICARE: PAM THOMPSON

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	103TC0700X	Clinical Psychologist	PSY8367	CA

General Provider Information

NPI Number	:	1831236918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAM THOMPSON

Provider Business Mailing Address
First Line	:	6101 W CENTINELA AVE
Second Line	:	SUITE 150
City	:	CULVER CITY
State	:	CA
Zip	:	90230-6337
Country	:	US
Telephone Number	:	310-988-1970
Fax Number	:

Provider Business Practice Location Address
First Line	:	6101 W CENTINELA AVE
Second Line	:	SUITE 150
City	:	CULVER CITY
State	:	CA
Zip	:	90230-6337
Country	:	US
Telephone Number	:	310-988-1970
Fax Number	:

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	04/15/2011

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Directions to “ PAM THOMPSON ” Practice Location

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