Healthcare Provider Details

I. General information

NPI: 1770667859
Provider Name (Legal Business Name): JOHN MICHAEL JAMESON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 04/15/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 SOUTHWINDS RD STE 5
FARMINGTON AR
72730-8685
US

IV. Provider business mailing address

128 SOUTHWINDS RD STE 5
FARMINGTON AR
72730-8685
US

V. Phone/Fax

Practice location:
  • Phone: 479-267-6934
  • Fax: 866-789-3345
Mailing address:
  • Phone: 479-267-6934
  • Fax: 866-789-3345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number95-22P
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: