Healthcare Provider Details

I. General information

NPI: 1023994167
Provider Name (Legal Business Name): JASMINE A CANTU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 SWISS AVE
DALLAS TX
75204-6225
US

IV. Provider business mailing address

4632 JUNIUS ST
DALLAS TX
75246-1090
US

V. Phone/Fax

Practice location:
  • Phone: 469-862-8301
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number95109
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number618814
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: