Provider Demographics
NPI:1124348651
Name:GERHARD-JOHNSON, PAMELA KATHLYN
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:KATHLYN
Last Name:GERHARD-JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4954 BILOXI AVE
Mailing Address - Street 2:
Mailing Address - City:N HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-4813
Mailing Address - Country:US
Mailing Address - Phone:714-865-8158
Mailing Address - Fax:
Practice Address - Street 1:3808 W RIVERSIDE DR STE 500
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-5301
Practice Address - Country:US
Practice Address - Phone:714-865-8158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-07
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47701106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist