Provider Demographics
NPI:1083136246
Name:JAMIESON, MICHAELA M (LPC)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:M
Last Name:JAMIESON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 CRESTHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3833
Mailing Address - Country:US
Mailing Address - Phone:901-682-6136
Mailing Address - Fax:901-682-7136
Practice Address - Street 1:1037 CRESTHAVEN RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3833
Practice Address - Country:US
Practice Address - Phone:901-682-6136
Practice Address - Fax:901-682-7136
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3966101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3966OtherLICENSE NUMBER