Provider Demographics
NPI:1730237934
Name:DAVIS, PAMELA JO (MFT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:JO
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 E 11TH ST STE 117
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-4089
Mailing Address - Country:US
Mailing Address - Phone:209-833-0805
Mailing Address - Fax:209-833-0806
Practice Address - Street 1:68 E 11TH ST STE 117
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-4089
Practice Address - Country:US
Practice Address - Phone:209-833-0805
Practice Address - Fax:209-833-0806
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39927106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist