Provider Demographics
NPI:1497743199
Name:KING, JAMIE MICHELLE (PHD)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:MICHELLE
Last Name:KING
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 S MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-5385
Mailing Address - Country:US
Mailing Address - Phone:724-221-6394
Mailing Address - Fax:724-420-5593
Practice Address - Street 1:1275 S MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-5385
Practice Address - Country:US
Practice Address - Phone:724-221-6394
Practice Address - Fax:724-420-5593
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2023-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017392103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102843952Medicaid