Basic Information
| Provider Information | |||||||||
| NPI: | 1306820394 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JUNE | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 827 | ||||||||
| Address2: | |||||||||
| City: | KATHLEEN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338490827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3174907994 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6804 CECELIA DR | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | NEW PORT RICHEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346534935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7272320644 | ||||||||
| FaxNumber: | 8885460488 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2005 | ||||||||
| LastUpdateDate: | 10/05/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 20040733A | IN | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC0700X | PY 9551 | FL | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | PY9551 | 01 | FL | FL STATE LICENSE | OTHER | 100218080 | 05 | IN | MEDICAID |