Provider Demographics
NPI:1649678640
Name:KELLY JAMESON, PHD
Entity type:Organization
Organization Name:KELLY JAMESON, PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMESON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:214-578-2551
Mailing Address - Street 1:6750 HILLCREST PLAZA DR
Mailing Address - Street 2:SUITE 221
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1400
Mailing Address - Country:US
Mailing Address - Phone:214-578-2551
Mailing Address - Fax:
Practice Address - Street 1:6750 HILLCREST PLAZA DR
Practice Address - Street 2:SUITE 221
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1400
Practice Address - Country:US
Practice Address - Phone:214-578-2551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66080302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization