Healthcare Provider Details

I. General information

NPI: 1518808997
Provider Name (Legal Business Name): MR. TERRY MAURICE JASPER JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3308 OASIS SPRINGS RD NE
RIO RANCHO NM
87144-2579
US

IV. Provider business mailing address

95-061 KAULUA ST
MILILANI HI
96789-1509
US

V. Phone/Fax

Practice location:
  • Phone: 808-489-3007
  • Fax:
Mailing address:
  • Phone: 808-489-3007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2024-0076
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: