Provider Demographics
NPI:1780974907
Name:ZAMORA, JAIME (CADC 1, ADES)
Entity type:Individual
Prefix:MR
First Name:JAIME
Middle Name:
Last Name:ZAMORA
Suffix:
Gender:M
Credentials:CADC 1, ADES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 NE COURT ST
Mailing Address - Street 2:
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754-1936
Mailing Address - Country:US
Mailing Address - Phone:541-447-7441
Mailing Address - Fax:
Practice Address - Street 1:365 NE COURT ST
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-1936
Practice Address - Country:US
Practice Address - Phone:541-447-7441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR06-11-69101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)