MEDICARE: JASEMINE MONET LAKEY BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-19-39990	CA

General Provider Information

NPI Number	:	1043859986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASEMINE MONET LAKEY BCBA

Provider Business Mailing Address
First Line	:	930 S MOUNT VERNON AVE STE 90
Second Line	:
City	:	COLTON
State	:	CA
Zip	:	92324-3928
Country	:	US
Telephone Number	:	951-550-3396
Fax Number	:	840-788-5546

Provider Business Practice Location Address
First Line	:	930 S MOUNT VERNON AVE STE 90
Second Line	:
City	:	COLTON
State	:	CA
Zip	:	92324-3928
Country	:	US
Telephone Number	:	951-550-3396
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2019
Last Update Date	:	02/27/2025

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