Provider Demographics
NPI:1801437322
Name:MEDCALF, JAMISON BROGAN (AMFT)
Entity type:Individual
Prefix:MR
First Name:JAMISON
Middle Name:BROGAN
Last Name:MEDCALF
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3426 ALDER CANYON WAY
Mailing Address - Street 2:
Mailing Address - City:ANTELOPE
Mailing Address - State:CA
Mailing Address - Zip Code:95843-4989
Mailing Address - Country:US
Mailing Address - Phone:916-272-5665
Mailing Address - Fax:
Practice Address - Street 1:2580 VICTOR AVE STE C
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1455
Practice Address - Country:US
Practice Address - Phone:530-722-9092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-06
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASUDRC10234101YA0400X
CAAMFT114404106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAMFT114404OtherBOARD OF BEHAVIORAL SCIENCES
CASUDRC10234OtherCADTP