Provider Demographics
NPI:1831418706
Name:DANA, JAMIE (MC, LPC)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:DANA
Suffix:
Gender:F
Credentials:MC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21436 N 78TH DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-3337
Mailing Address - Country:US
Mailing Address - Phone:602-695-8398
Mailing Address - Fax:
Practice Address - Street 1:18205 N 51ST AVE STE 131
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1492
Practice Address - Country:US
Practice Address - Phone:602-499-5329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-12485101YM0800X
AZLPC-16093101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health