Provider Demographics
NPI:1205354636
Name:CHALLENDER, PAMELA ELLEN (LMFT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:ELLEN
Last Name:CHALLENDER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-3823
Mailing Address - Country:US
Mailing Address - Phone:415-897-1092
Mailing Address - Fax:
Practice Address - Street 1:631 WILSON AVE
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-3823
Practice Address - Country:US
Practice Address - Phone:415-897-1092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42017106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist