Provider Demographics
NPI:1467541094
Name:TAXE, PAMELA W (PHD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:W
Last Name:TAXE
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 1:310 NORTH WESTLAKE BLVD
Mailing Address - Street 2:SUITE # 130
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362
Mailing Address - Country:US
Mailing Address - Phone:805-446-6572
Mailing Address - Fax:805-446-6574
Practice Address - Street 1:310 NORTH WESTLAKE BLVD
Practice Address - Street 2:SUITE # 130
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362
Practice Address - Country:US
Practice Address - Phone:805-446-6572
Practice Address - Fax:805-446-6574
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7401103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OOPL7401OtherBLUE SHIELD
CP7401Medicare ID - Type Unspecified