Provider Demographics
NPI:1386982627
Name:MACK, JAMILYN MARIE (MS, LMFT-A)
Entity type:Individual
Prefix:
First Name:JAMILYN
Middle Name:MARIE
Last Name:MACK
Suffix:
Gender:F
Credentials:MS, LMFT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29211 LEGENDS GREEN DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-3583
Mailing Address - Country:US
Mailing Address - Phone:832-768-0771
Mailing Address - Fax:
Practice Address - Street 1:2203 TIMBERLOCH PL
Practice Address - Street 2:SUITE 100
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-1150
Practice Address - Country:US
Practice Address - Phone:832-768-0771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201813106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist