Provider Demographics
NPI:1508457458
Name:JAMIESON, TRACI C (LPC)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:C
Last Name:JAMIESON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 768
Mailing Address - Street 2:
Mailing Address - City:MCCALL
Mailing Address - State:ID
Mailing Address - Zip Code:83638-0768
Mailing Address - Country:US
Mailing Address - Phone:208-630-4200
Mailing Address - Fax:
Practice Address - Street 1:125 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:MCCALL
Practice Address - State:ID
Practice Address - Zip Code:83638-5192
Practice Address - Country:US
Practice Address - Phone:208-634-2962
Practice Address - Fax:208-634-5064
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID8007101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty