Basic Information
| Provider Information | |||||||||
| NPI: | 1467937383 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VILLEMONTE | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | HELENE | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 906 MAIN AVE | ||||||||
| Address2: | |||||||||
| City: | TILLAMOOK | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971413816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038428201 | ||||||||
| FaxNumber: | 5038151870 | ||||||||
| Practice Location | |||||||||
| Address1: | 906 MAIN AVE | ||||||||
| Address2: | |||||||||
| City: | TILLAMOOK | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971413816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038428201 | ||||||||
| FaxNumber: | 5038151870 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2018 | ||||||||
| LastUpdateDate: | 07/22/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | L8159 | OR | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | LSW.0009921310 | CO | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.