Provider Demographics
NPI:1336989011
Name:JAMES, PAMELA MERCEDES
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:MERCEDES
Last Name:JAMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2890 INLAND EMPIRE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-4649
Mailing Address - Country:US
Mailing Address - Phone:909-489-6196
Mailing Address - Fax:
Practice Address - Street 1:2890 INLAND EMPIRE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-4649
Practice Address - Country:US
Practice Address - Phone:909-489-6196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT140654106H00000X
CAAPCC14991101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health