Provider Demographics
NPI:1750387197
Name:JAMISON, DAVID LEE (MS, DMIN)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LEE
Last Name:JAMISON
Suffix:
Gender:M
Credentials:MS, DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3265 19TH ST NW STE 170
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-6786
Mailing Address - Country:US
Mailing Address - Phone:507-273-8971
Mailing Address - Fax:
Practice Address - Street 1:2801 55TH ST NW
Practice Address - Street 2:STE 2
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-4187
Practice Address - Country:US
Practice Address - Phone:507-288-3118
Practice Address - Fax:507-287-0703
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN175106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist