MEDICARE: MISS BERNADETTE A JASPER LMHC, CAP

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	101YM0800X	Mental Health Counselor	MH7836	FL

General Provider Information

NPI Number	:	1174707699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS BERNADETTE A JASPER LMHC, CAP

Provider Business Mailing Address
First Line	:	3521 W BROWARD BLVD FL 3
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33312-1048
Country	:	US
Telephone Number	:	954-587-1008
Fax Number	:	954-587-0080

Provider Business Practice Location Address
First Line	:	3521 W BROWARD BLVD FL 3
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33312-1048
Country	:	US
Telephone Number	:	954-587-1008
Fax Number	:	954-587-0080

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

Provider Enumeration Date	:	12/19/2007
Last Update Date	:	12/19/2007

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