Provider Demographics
NPI:1447557954
Name:PAMELA M. NILSSON, PH.D., LLC
Entity Type:Organization
Organization Name:PAMELA M. NILSSON, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:NILSSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:216-789-3878
Mailing Address - Street 1:23811 CHAGRIN BLVD STE 248
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5560
Mailing Address - Country:US
Mailing Address - Phone:216-299-6843
Mailing Address - Fax:216-920-6288
Practice Address - Street 1:23811 CHAGRIN BLVD STE 248
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5560
Practice Address - Country:US
Practice Address - Phone:216-789-3878
Practice Address - Fax:216-920-6288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6455261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health