MEDICARE: JAZZMINE CHIREE KELLY

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	101YP2500X	Professional Counselor	100013	TX

General Provider Information

NPI Number	:	1144152893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAZZMINE CHIREE KELLY

Provider Business Mailing Address
First Line	:	5318 LAS CAMPANAS ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78233-5522
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1919 OAKWELL FARMS PKWY STE 155
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218-1777
Country	:	US
Telephone Number	:	210-201-4578
Fax Number	:

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

Provider Enumeration Date	:	05/29/2026
Last Update Date	:	05/29/2026

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