Provider Demographics
NPI:1760116545
Name:ISAIAH D. JAMISON COMMUNITY WELLNESS CENTER
Entity Type:Organization
Organization Name:ISAIAH D. JAMISON COMMUNITY WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AUTRY
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMISON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:408-806-1888
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:408-806-1888
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:408-806-1888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-15
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty