Healthcare Provider Details

I. General information

NPI: 1376242560
Provider Name (Legal Business Name): JAMIE S DAUGHDRILL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 VILLA ST
MOUNTAIN VIEW CA
94041-1236
US

IV. Provider business mailing address

1027 BROKEN TRAIL CT
SUGAR LAND TX
77479
US

V. Phone/Fax

Practice location:
  • Phone: 832-216-6175
  • Fax:
Mailing address:
  • Phone: 832-216-6175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number60696
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: