Provider Demographics
NPI:1336401066
Name:PEDERSEN, JAMIE (LPCC)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8800 SIERRA COLLEGE BLVD., APT. 714
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661
Mailing Address - Country:US
Mailing Address - Phone:817-368-5722
Mailing Address - Fax:916-749-3184
Practice Address - Street 1:1665 CREEKSIDE DR STE 106
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3538
Practice Address - Country:US
Practice Address - Phone:817-368-5722
Practice Address - Fax:916-749-3184
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPC 23101YP2500X
TX64331101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional