Healthcare Provider Details

I. General information

NPI: 1255847372
Provider Name (Legal Business Name): JASMINE BROWN LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2017
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 E CHAUNCEY LN APT 2081
PHOENIX AZ
85054-5123
US

IV. Provider business mailing address

6901 E CHAUNCEY LN APT 2081
PHOENIX AZ
85054-5123
US

V. Phone/Fax

Practice location:
  • Phone: 678-460-0345
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLAC-23366
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: