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General NPI Number Information
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NPI Number | 1497885628
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Entity Type | Individual
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Provider Name | JASMINA R. MOORE M.F.T.
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Gender | Female
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 02/21/2012
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Provider Practice Location Address
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Address Line | 115 S PARKSIDE DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80910-3130
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Country | US
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Telephone | 719-447-4775
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Fax |
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Provider Business Mailing Address
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Address Line | 17635 GRAMA RDG
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City | COLORADO SPRINGS
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State | CO
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Zip | 80908-1359
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Country | US
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Telephone | 719-358-9332
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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 | MFC34960
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License Number State | CA
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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 | 914
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License Number State | CO
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