Provider Demographics
NPI:1770667859
Name:JAMESON, JOHN MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:JAMESON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 SOUTHWINDS RD STE 5
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:AR
Mailing Address - Zip Code:72730-8685
Mailing Address - Country:US
Mailing Address - Phone:479-267-6934
Mailing Address - Fax:866-789-3345
Practice Address - Street 1:128 SOUTHWINDS RD STE 5
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:AR
Practice Address - Zip Code:72730-8685
Practice Address - Country:US
Practice Address - Phone:479-267-6934
Practice Address - Fax:866-789-3345
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR95-22P103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR128264719Medicaid