Provider Demographics
NPI:1912578303
Name:JAMISON, WENDY STAFFORD (LPC, LCDC)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:STAFFORD
Last Name:JAMISON
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2033 S GESSNER RD APT 3311
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-1171
Mailing Address - Country:US
Mailing Address - Phone:713-540-1077
Mailing Address - Fax:
Practice Address - Street 1:12301 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77035-6207
Practice Address - Country:US
Practice Address - Phone:713-275-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14786101YA0400X
TX61538101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)