Provider Demographics
NPI:1386073815
Name:JEFFERY, JAMIE ADAMS
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:ADAMS
Last Name:JEFFERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:ADAMS
Other - Last Name:VAIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:3450 E SIERRA MADRE AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-1970
Mailing Address - Country:US
Mailing Address - Phone:480-228-2419
Mailing Address - Fax:
Practice Address - Street 1:3450 E SIERRA MADRE AVE
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-1970
Practice Address - Country:US
Practice Address - Phone:480-228-2419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-12608101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health