Healthcare Provider Details

I. General information

NPI: 1194343723
Provider Name (Legal Business Name): GILL WAYNE JASMINE JR. LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 NORTH BLVD
BATON ROUGE LA
70806-3825
US

IV. Provider business mailing address

26579 OLD BARNWOOD DR
DENHAM SPRINGS LA
70726-5901
US

V. Phone/Fax

Practice location:
  • Phone: 225-655-6422
  • Fax:
Mailing address:
  • Phone: 985-817-5705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8488
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: