Provider Demographics
NPI:1821850173
Name:JOHANSEN, PAMELA STOWERS
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:STOWERS
Last Name:JOHANSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BUTTE COUNTY JAIL MEDICAL UNIT
Mailing Address - Street 2:5 GILLICK WAY
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95965
Mailing Address - Country:US
Mailing Address - Phone:530-538-7593
Mailing Address - Fax:
Practice Address - Street 1:BUTTE COUNTY JAIL MEDICAL UNIT
Practice Address - Street 2:5 GILLICK WAY
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95965
Practice Address - Country:US
Practice Address - Phone:530-538-7593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS14640101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health