Provider Demographics
NPI:1295105948
Name:JAMISON, KATHARINE (LCPC)
Entity type:Individual
Prefix:
First Name:KATHARINE
Middle Name:
Last Name:JAMISON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 S 7TH AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-5871
Mailing Address - Country:US
Mailing Address - Phone:208-589-2677
Mailing Address - Fax:
Practice Address - Street 1:1133 N MAIN ST
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204-2717
Practice Address - Country:US
Practice Address - Phone:208-234-9361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID5984101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health