Healthcare Provider Details

I. General information

NPI: 1316921018
Provider Name (Legal Business Name): NANCY GAYLE JAMERSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NANCY GAYLE DONAHOO LCSW

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 03/16/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BARTON COUNTY HEALTH DEPARTMENT 1301 EAST 12TH ST.
LAMAR MO
64759-6475
US

IV. Provider business mailing address

1203 E 18TH ST
LAMAR MO
64759-2416
US

V. Phone/Fax

Practice location:
  • Phone: 417-214-3966
  • Fax:
Mailing address:
  • Phone: 417-214-3966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number000619
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number000619
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number000619
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: