Provider Demographics
NPI:1588373070
Name:KLEMASHEVICH, JAMIE (PHD)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:KLEMASHEVICH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 E WHIRLWIND WAY
Mailing Address - Street 2:
Mailing Address - City:SAFFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85546-2182
Mailing Address - Country:US
Mailing Address - Phone:504-383-3705
Mailing Address - Fax:
Practice Address - Street 1:1555 E WHIRLWIND WAY
Practice Address - Street 2:
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546-2182
Practice Address - Country:US
Practice Address - Phone:504-383-3705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84895101YP2500X
LA7458101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional