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General NPI Number Information
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NPI Number | 1962000984
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Entity Type | Individual
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Provider Name | MYLENE GRACE VILLANUEVA JASMIN
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Gender | Female
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Dates
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Enumeration Date | 10/12/2020
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 851 S SUNSET AVE APT 98
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City | WEST COVINA
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State | CA
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Zip | 91790-5542
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Country | US
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Telephone | 626-869-8525
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Fax |
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Provider Business Mailing Address
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Address Line | 13630 FOSTER AVE APT 34
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City | BALDWIN PARK
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State | CA
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Zip | 91706-4846
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Country | US
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Telephone | 626-869-8525
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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 | 151192
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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 | 120427
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | AMFT120427
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License Number State | CA
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