Healthcare Provider Details

I. General information

NPI: 1295117778
Provider Name (Legal Business Name): JASMYN L HENDERSON LPC-INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2015
Last Update Date: 07/31/2020
Certification Date: 07/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 GUADALUPE ST
AUSTIN TX
78705-5618
US

IV. Provider business mailing address

7300 BLANCO RD STE 501
SAN ANTONIO TX
78216-4941
US

V. Phone/Fax

Practice location:
  • Phone: 313-805-1519
  • Fax:
Mailing address:
  • Phone: 210-446-8255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number73894
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: