=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720736143
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. JASMINE MITCHELL FRAZIER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2022
-----------------------------------------------------
Last Update Date | 03/15/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8414 E SHEA BLVD STE 102
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85260-6665
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-478-5636
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20802 N GRAYHAWK DR UNIT 1031
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85255-6433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-986-3755
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | LAC-19666
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------