Provider Demographics
NPI:1982990875
Name:PAULSON, PAMELA J (LMFT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:PAULSON
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 1:1212 OCEAN AVE
Mailing Address - Street 2:B
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-6488
Mailing Address - Country:US
Mailing Address - Phone:213-300-7023
Mailing Address - Fax:
Practice Address - Street 1:1801 PARK COURT PL
Practice Address - Street 2:E203
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-5002
Practice Address - Country:US
Practice Address - Phone:213-300-7023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT40363106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist