Provider Demographics
NPI:1164976148
Name:JAMESON, PAULA (MA, MFT)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:JAMESON
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 CENTRAL BLVD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-2242
Mailing Address - Country:US
Mailing Address - Phone:562-972-4817
Mailing Address - Fax:
Practice Address - Street 1:1210 CENTRAL BLVD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-2242
Practice Address - Country:US
Practice Address - Phone:562-972-4817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40832106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist