Healthcare Provider Details

I. General information

NPI: 1730728072
Provider Name (Legal Business Name): JASMINE MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2020
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6444 JONES CREEK RD APT 903
BATON ROUGE LA
70817-3074
US

IV. Provider business mailing address

5547 N FOSTER DR
BATON ROUGE LA
70805-1813
US

V. Phone/Fax

Practice location:
  • Phone: 225-588-5554
  • Fax:
Mailing address:
  • Phone: 225-588-3554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8672
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: