Provider Demographics
NPI:1255357976
Name:HALL, PAMELA JEAN (PHD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:JEAN
Last Name:HALL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9836
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92375-3036
Mailing Address - Country:US
Mailing Address - Phone:909-213-1852
Mailing Address - Fax:909-793-7370
Practice Address - Street 1:1799 N WATERMAN AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNADINO
Practice Address - State:CA
Practice Address - Zip Code:92404
Practice Address - Country:US
Practice Address - Phone:909-213-1852
Practice Address - Fax:909-793-7370
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16906103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical