Provider Demographics
NPI:1699706168
Name:LAW, JAMISON DOUGLAS (CPCI)
Entity type:Individual
Prefix:
First Name:JAMISON
Middle Name:DOUGLAS
Last Name:LAW
Suffix:
Gender:M
Credentials:CPCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3812 CHILTON CIRCLE
Mailing Address - Street 2:
Mailing Address - City:EAGLE MOUNTIAN
Mailing Address - State:UT
Mailing Address - Zip Code:84005
Mailing Address - Country:US
Mailing Address - Phone:801-789-6023
Mailing Address - Fax:801-263-6370
Practice Address - Street 1:32 W WINCHESTER ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-5607
Practice Address - Country:US
Practice Address - Phone:801-263-6367
Practice Address - Fax:801-236-3670
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT56338026009101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional