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General NPI Number Information
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NPI Number | 1326394347
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Entity Type | Individual
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Provider Name | JAMESON MICHAEL MAYBERRY MA, CADC
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Gender | Male
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Dates
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Enumeration Date | 07/27/2012
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Last Update Date | 07/27/2012
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Provider Practice Location Address
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Address Line | 1520 6TH ST SW
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City | MASON CITY
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State | IA
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Zip | 50401-4820
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Country | US
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Telephone | 641-423-4180
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Fax | 641-421-6023
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Provider Business Mailing Address
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Address Line | 1520 6TH ST SW
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City | MASON CITY
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State | IA
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Zip | 50401-4820
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Country | US
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Telephone | 641-423-4180
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Fax | 641-421-6023
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 000355
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License Number State | IA
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