Provider Demographics
NPI:1598082224
Name:SHIELDS, JAMIE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:
Last Name:SHIELDS
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 1:800 ROCKMEAD DR STE 113
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-5019
Mailing Address - Country:US
Mailing Address - Phone:832-348-3713
Mailing Address - Fax:844-411-8973
Practice Address - Street 1:800 ROCKMEAD DR STE 113
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-5019
Practice Address - Country:US
Practice Address - Phone:832-348-3713
Practice Address - Fax:844-411-8973
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2020-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64268101YP2500X
101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX210518102Medicaid