Provider Demographics
NPI:1306820394
Name:JUNE, PAMELA LYNN (PHD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:LYNN
Last Name:JUNE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 827
Mailing Address - Street 2:
Mailing Address - City:KATHLEEN
Mailing Address - State:FL
Mailing Address - Zip Code:33849-0827
Mailing Address - Country:US
Mailing Address - Phone:317-490-7994
Mailing Address - Fax:
Practice Address - Street 1:6804 CECELIA DR
Practice Address - Street 2:SUITE 201
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-4935
Practice Address - Country:US
Practice Address - Phone:727-232-0644
Practice Address - Fax:888-546-0488
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040733A103TC0700X
FLPY 9551103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPY9551OtherFL STATE LICENSE
IN100218080Medicaid
IN100218080Medicaid
IN675560PMedicare PIN