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General NPI Number Information
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NPI Number | 1528537354
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Entity Type | Individual
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Provider Name | JASMINE MERI NIEVES MORALES MA, RMHCI
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Gender | Female
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Dates
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Enumeration Date | 11/22/2018
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Last Update Date | 11/22/2018
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Provider Practice Location Address
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Address Line | 17356 US HIGHWAY 301 N
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City | STARKE
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State | FL
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Zip | 32091-1619
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Country | US
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Telephone | 904-290-6600
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Fax |
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Provider Business Mailing Address
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Address Line | 1718 PENZANCE PKWY
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City | MIDDLEBURG
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State | FL
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Zip | 32068-3940
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Country | US
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Telephone | 340-332-8918
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | RMHCI15670
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License Number State | FL
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