Provider Demographics
NPI:1184240186
Name:MEKKELSEN, JAMIE MARIE (BT)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:MARIE
Last Name:MEKKELSEN
Suffix:
Gender:F
Credentials:BT
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:MARIE
Other - Last Name:ANESHANSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2870 N LA CIENEGA DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-3531
Mailing Address - Country:US
Mailing Address - Phone:520-631-5800
Mailing Address - Fax:
Practice Address - Street 1:4501 N CAMINO DEL OBISPO
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-6605
Practice Address - Country:US
Practice Address - Phone:520-302-1159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician