Healthcare Provider Details

I. General information

NPI: 1073245387
Provider Name (Legal Business Name): JASMINE VICTORIA IDROGO MS, NCC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11220 W LOOP 1604 N STE 119
SAN ANTONIO TX
78254-6600
US

IV. Provider business mailing address

13999 OLD BLANCO RD APT 1512
SAN ANTONIO TX
78216-7785
US

V. Phone/Fax

Practice location:
  • Phone: 210-956-2922
  • Fax:
Mailing address:
  • Phone: 210-956-2922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number89015
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: