Provider Demographics
NPI:1831498690
Name:JAIMES, JAMI ELIZABETH (M ED, LISAC)
Entity Type:Individual
Prefix:
First Name:JAMI
Middle Name:ELIZABETH
Last Name:JAIMES
Suffix:
Gender:F
Credentials:M ED, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 S COUNTRY CLUB DR
Mailing Address - Street 2:SUITE 41
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-6809
Mailing Address - Country:US
Mailing Address - Phone:480-497-4042
Mailing Address - Fax:
Practice Address - Street 1:2150 S COUNTRY CLUB DR
Practice Address - Street 2:SUITE 41
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6809
Practice Address - Country:US
Practice Address - Phone:480-497-4042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-19
Last Update Date:2011-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11754101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)