Provider Demographics
NPI:1992197248
Name:RISS, PAMELA A (LMFT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:A
Last Name:RISS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:A
Other - Last Name:ASPINWALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2775 TAPO STREET
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063
Mailing Address - Country:US
Mailing Address - Phone:805-795-3329
Mailing Address - Fax:
Practice Address - Street 1:2775 TAPO STREET
Practice Address - Street 2:SUITE 204
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063
Practice Address - Country:US
Practice Address - Phone:805-795-3329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC48269106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist