Provider Demographics
NPI:1407637937
Name:DOUGLAS, JAMIE LYNNE (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:LYNNE
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 VERMONT ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-3746
Mailing Address - Country:US
Mailing Address - Phone:505-314-4343
Mailing Address - Fax:
Practice Address - Street 1:7007 WYOMING BLVD NE STE D5
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3981
Practice Address - Country:US
Practice Address - Phone:505-298-3303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2023-0723101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health