Provider Demographics
NPI:1245452861
Name:AWANA, PAMELA R (PHD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:R
Last Name:AWANA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:ROBISON-AWANA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:111 E. 5600 SO.
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107
Mailing Address - Country:US
Mailing Address - Phone:801-261-3449
Mailing Address - Fax:801-261-8670
Practice Address - Street 1:111 E. 5600 SO.
Practice Address - Street 2:SUITE 310
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107
Practice Address - Country:US
Practice Address - Phone:801-261-3449
Practice Address - Fax:801-261-8670
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT115860-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist