Provider Demographics
NPI:1598965618
Name:PANNELL, JAMES JR (LMFT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:PANNELL
Suffix:JR
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 GRAY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-3201
Mailing Address - Country:US
Mailing Address - Phone:530-300-1927
Mailing Address - Fax:530-673-1955
Practice Address - Street 1:1133 GRAY AVE STE B
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-3201
Practice Address - Country:US
Practice Address - Phone:530-300-1927
Practice Address - Fax:530-673-1955
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 40612106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MFC 40612OtherLICENSED MARRIAGE & FAMIL