Healthcare Provider Details

I. General information

NPI: 1114493210
Provider Name (Legal Business Name): JASMINE LACHELLE COHEN-YOUNG LSCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2018
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 HUEBNER RD
FORT RILEY KS
66442-4030
US

IV. Provider business mailing address

5501 ABERCORN STREET UNIT 5 - #102
SAVANNAH GA
31405
US

V. Phone/Fax

Practice location:
  • Phone: 785-239-7000
  • Fax: 630-570-5779
Mailing address:
  • Phone: 762-901-2297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number05347
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW007279
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number05347
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: