Provider Demographics
NPI:1104994284
Name:JAMISON PROFESSIONAL COUNSELING CENTER INC
Entity type:Organization
Organization Name:JAMISON PROFESSIONAL COUNSELING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:JAMISON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:325-829-9446
Mailing Address - Street 1:PO BOX 1116
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-1116
Mailing Address - Country:US
Mailing Address - Phone:325-829-9446
Mailing Address - Fax:
Practice Address - Street 1:111 SONGBIRD DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-5447
Practice Address - Country:US
Practice Address - Phone:325-829-9446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0057941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX306522902Medicaid
TXTXB111693Medicare PIN