Basic Information
| Provider Information | |||||||||
| NPI: | 1831236025 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBERTS | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | SUZETTE | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3191 CHURN CREEK RD | ||||||||
| Address2: | |||||||||
| City: | REDDING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 96002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302247160 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3191 CHURN CREEK RD | ||||||||
| Address2: | |||||||||
| City: | REDDING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 96002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302247160 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2007 | ||||||||
| LastUpdateDate: | 01/14/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC47555 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.