Provider Demographics
NPI:1386004604
Name:MOUSSEAU, PAMELA
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:
Last Name:MOUSSEAU
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:MOUSSEAU-JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1334 POST AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-2620
Mailing Address - Country:US
Mailing Address - Phone:310-328-1460
Mailing Address - Fax:
Practice Address - Street 1:1334 POST AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-2620
Practice Address - Country:US
Practice Address - Phone:310-328-1460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)