Provider Demographics
NPI:1215696471
Name:JAMESON, AMANDA DAWN
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:DAWN
Last Name:JAMESON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W FM 544 STE 111
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-4229
Mailing Address - Country:US
Mailing Address - Phone:972-423-9005
Mailing Address - Fax:866-874-2850
Practice Address - Street 1:601 W FM 544 STE 111
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:TX
Practice Address - Zip Code:75094-4229
Practice Address - Country:US
Practice Address - Phone:972-423-9005
Practice Address - Fax:866-874-2850
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-14
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-25-79502103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst