Provider Demographics
NPI:1558695841
Name:LEWIS, PAMELA JEAN (LMFT #84275)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEAN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LMFT #84275
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 S STATE COLLEGE BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-5728
Mailing Address - Country:US
Mailing Address - Phone:714-904-5049
Mailing Address - Fax:714-455-7025
Practice Address - Street 1:405 S STATE COLLEGE BLVD STE 204
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5728
Practice Address - Country:US
Practice Address - Phone:714-904-5049
Practice Address - Fax:714-455-7025
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84275106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist