Provider Demographics
NPI:1629505771
Name:JAMISON, AUTRY (MA)
Entity Type:Individual
Prefix:MRS
First Name:AUTRY
Middle Name:
Last Name:JAMISON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4635 LA BAHIA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-5086
Mailing Address - Country:US
Mailing Address - Phone:408-806-8888
Mailing Address - Fax:
Practice Address - Street 1:4635 LA BAHIA WAY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-5086
Practice Address - Country:US
Practice Address - Phone:408-806-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-19
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204640106H00000X
CA115633106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist