Healthcare Provider Details

I. General information

NPI: 1801437322
Provider Name (Legal Business Name): JAMISON BROGAN MEDCALF LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2019
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1669 PORTELLO WAY
LINCOLN CA
95648-8910
US

IV. Provider business mailing address

1669 PORTELLO WAY
LINCOLN CA
95648-8910
US

V. Phone/Fax

Practice location:
  • Phone: 916-272-5665
  • Fax:
Mailing address:
  • Phone: 916-272-5665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberSUDRC10234
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT163840
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: