Healthcare Provider Details

I. General information

NPI: 1942721808
Provider Name (Legal Business Name): JASMINE TEMPLETON LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2017
Last Update Date: 01/31/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 IRONWOOD CT
ROSEDALE MD
21237-4071
US

IV. Provider business mailing address

128 IRONWOOD CT
ROSEDALE MD
21237-4071
US

V. Phone/Fax

Practice location:
  • Phone: 802-324-2510
  • Fax:
Mailing address:
  • Phone: 802-324-2510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC8807
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: