Provider Demographics
NPI:1326394347
Name:MAYBERRY, JAMESON MICHAEL (MA, CADC)
Entity Type:Individual
Prefix:
First Name:JAMESON
Middle Name:MICHAEL
Last Name:MAYBERRY
Suffix:
Gender:M
Credentials:MA, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 6TH ST SW
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-4820
Mailing Address - Country:US
Mailing Address - Phone:641-423-4180
Mailing Address - Fax:641-421-6023
Practice Address - Street 1:1520 6TH ST SW
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-4820
Practice Address - Country:US
Practice Address - Phone:641-423-4180
Practice Address - Fax:641-421-6023
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000355106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist