Healthcare Provider Details

I. General information

NPI: 1396468179
Provider Name (Legal Business Name): JASMINE WILSON LMHC, LPC, MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JASMINE TILDEN

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8490 MUKILTEO SPEEDWAY STE 112
MUKILTEO WA
98275-3208
US

IV. Provider business mailing address

8490 MUKILTEO SPEEDWAY STE 112
MUKILTEO WA
98275-3208
US

V. Phone/Fax

Practice location:
  • Phone: 425-309-7942
  • Fax: 425-551-7227
Mailing address:
  • Phone: 619-693-2586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC021194
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61596242
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number12956
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: