Provider Demographics
NPI:1184750622
Name:JAMESON, HEATHER AMIE (MS, LMHC, LPC)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:AMIE
Last Name:JAMESON
Suffix:
Gender:F
Credentials:MS, LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 812 BOX 2126
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09627-0022
Mailing Address - Country:US
Mailing Address - Phone:347-835-6216
Mailing Address - Fax:
Practice Address - Street 1:481 SERENGETI DR
Practice Address - Street 2:
Practice Address - City:WINSTON
Practice Address - State:OR
Practice Address - Zip Code:97496-7517
Practice Address - Country:US
Practice Address - Phone:805-535-0484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60125441101YM0800X
ORC4230101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health