Provider Demographics
NPI:1710914270
Name:STJOHN, PAMELA ANNE (MFT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANNE
Last Name:STJOHN
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 1:1430 ESPLANADE
Mailing Address - Street 2:STE. 17
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3366
Mailing Address - Country:US
Mailing Address - Phone:530-898-0219
Mailing Address - Fax:530-898-0219
Practice Address - Street 1:1430 ESPLANADE
Practice Address - Street 2:STE. 17
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3366
Practice Address - Country:US
Practice Address - Phone:530-898-0219
Practice Address - Fax:530-898-0219
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC28126106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist