Provider Demographics
NPI:1487860995
Name:GILLETTE, PAMELA SUE (MFT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:SUE
Last Name:GILLETTE
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 1:1110 CALIFORNIA BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2971
Mailing Address - Country:US
Mailing Address - Phone:805-541-9499
Mailing Address - Fax:805-541-9410
Practice Address - Street 1:1110 CALIFORNIA BLVD STE E
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2971
Practice Address - Country:US
Practice Address - Phone:805-541-9499
Practice Address - Fax:805-541-9410
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC24440106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist