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General NPI Number Information
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NPI Number | 1184451478
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Entity Type | Individual
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Provider Name | JASMINE LEE BROOKS
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Gender | Female
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Dates
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Enumeration Date | 09/19/2024
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Last Update Date | 09/19/2024
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Provider Practice Location Address
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Address Line | 3010 ILLINOIS AVE STE 100
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City | KILLEEN
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State | TX
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Zip | 76543-5374
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Country | US
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Telephone | 254-432-7041
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Fax |
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Provider Business Mailing Address
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Address Line | 1401 WALES DR
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City | KILLEEN
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State | TX
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Zip | 76549-7932
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Country | US
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Telephone | 254-423-8220
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 1183370
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License Number State | TX
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