Provider Demographics
NPI:1619790995
Name:GAITHER, JAMIE BRYNN (PHD, NCSP)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:BRYNN
Last Name:GAITHER
Suffix:
Gender:F
Credentials:PHD, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 E NORTH DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-6595
Mailing Address - Country:US
Mailing Address - Phone:812-330-7745
Mailing Address - Fax:
Practice Address - Street 1:315 E NORTH DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-6595
Practice Address - Country:US
Practice Address - Phone:812-330-7745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10316408103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool