Provider Demographics
NPI:1083481949
Name:ABANAKA, JAMON (MS, LPC, LSOTP)
Entity Type:Individual
Prefix:MR
First Name:JAMON
Middle Name:
Last Name:ABANAKA
Suffix:
Gender:M
Credentials:MS, LPC, LSOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 WHISPERING OAKS DR
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-7407
Mailing Address - Country:US
Mailing Address - Phone:469-964-9782
Mailing Address - Fax:
Practice Address - Street 1:1180 WHISPERING OAKS DR
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-7407
Practice Address - Country:US
Practice Address - Phone:469-964-9782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health