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General NPI Number Information
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NPI Number | 1487040572
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Entity Type | Individual
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Provider Name | JASMIN YOUNG-BRADSHAW LMFT
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Gender | Female
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Dates
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Enumeration Date | 04/15/2015
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Last Update Date | 11/08/2023
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Provider Practice Location Address
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Address Line | 804 SALEM WOODS DR STE 202
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City | RALEIGH
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State | NC
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Zip | 27615-3343
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Country | US
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Telephone | 919-759-6756
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Fax |
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Provider Business Mailing Address
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Address Line | 5217 HOLLY RIDGE FARM RD
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City | RALEIGH
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State | NC
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Zip | 27616-8060
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Country | US
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Telephone | 562-522-7662
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 2018-068
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License Number State | ND
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 00666
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License Number State | NC
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