Provider Demographics
NPI:1518232891
Name:GARMAN, JAMIE LEE (BA,CARS)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:LEE
Last Name:GARMAN
Suffix:
Gender:F
Credentials:BA,CARS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2148 VADALABENE DR
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-5632
Mailing Address - Country:US
Mailing Address - Phone:618-288-3100
Mailing Address - Fax:618-288-3371
Practice Address - Street 1:2148 VADALABENE DR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-5632
Practice Address - Country:US
Practice Address - Phone:618-288-3100
Practice Address - Fax:618-288-3371
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL24530101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)