Provider Demographics
NPI:1043231715
Name:MCEVOY, PAMELA THOMPSON (PHD PSYCHOLOGIST)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:THOMPSON
Last Name:MCEVOY
Suffix:
Gender:F
Credentials:PHD PSYCHOLOGIST
Other - Prefix:DR
Other - First Name:PAMELA
Other - Middle Name:MCEVOY
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD PSYCHOLOGIST
Mailing Address - Street 1:PO BOX 2369
Mailing Address - Street 2:
Mailing Address - City:BORREGO SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92004-2369
Mailing Address - Country:US
Mailing Address - Phone:760-767-5051
Mailing Address - Fax:760-767-4552
Practice Address - Street 1:4343 YAQUI PASS ROAD
Practice Address - Street 2:
Practice Address - City:BORREGO SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92004-1198
Practice Address - Country:US
Practice Address - Phone:607-767-5051
Practice Address - Fax:607-767-4552
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC16993106H00000X
CAPSY10150103TC0700X
AZLMFT10239106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R14415Medicare UPIN
CAWCP10150DBAMedicare ID - Type Unspecified