Provider Demographics
NPI:1598733701
Name:MCLEMORE, JAMIE WINNINGHAM (LCSW)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:WINNINGHAM
Last Name:MCLEMORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:WINNINGHAM
Other - Last Name:MCLEMORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:650 BARTON RD
Mailing Address - Street 2:
Mailing Address - City:MAYPEARL
Mailing Address - State:TX
Mailing Address - Zip Code:76064-2010
Mailing Address - Country:US
Mailing Address - Phone:214-534-1673
Mailing Address - Fax:972-435-5804
Practice Address - Street 1:650 BARTON RD
Practice Address - Street 2:
Practice Address - City:MAYPEARL
Practice Address - State:TX
Practice Address - Zip Code:76064-7606
Practice Address - Country:US
Practice Address - Phone:214-534-1673
Practice Address - Fax:469-336-4060
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX267611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0052MROtherBCBS
TX176105801Medicaid
TX9391549OtherPHCS