Healthcare Provider Details

I. General information

NPI: 1093405052
Provider Name (Legal Business Name): JASMINE RICHARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2023
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1636 POPPS FERRY RD STE 203
BILOXI MS
39532-2309
US

IV. Provider business mailing address

1636 POPPS FERRY RD STE 203
BILOXI MS
39532-2309
US

V. Phone/Fax

Practice location:
  • Phone: 228-284-2644
  • Fax:
Mailing address:
  • Phone: 228-284-2644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP-1455
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: