Provider Demographics
NPI:1568652063
Name:JAMERSON, THERESA (MA LPC-S)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:JAMERSON
Suffix:
Gender:F
Credentials:MA LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N COIT RD STE 506
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-6657
Mailing Address - Country:US
Mailing Address - Phone:469-215-5713
Mailing Address - Fax:469-215-2523
Practice Address - Street 1:1400 N COIT RD STE 506
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-6657
Practice Address - Country:US
Practice Address - Phone:469-215-5713
Practice Address - Fax:469-215-2523
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010656101YP2500X
TX72896101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3855348Medicaid