MEDICARE: JAZMINE MARSHALL

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1194124859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAZMINE MARSHALL

Provider Business Mailing Address
First Line	:	13243 ITALIAN CYPRESS TRL
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77044-4071
Country	:	US
Telephone Number	:	281-900-8625
Fax Number	:	713-692-2157

Provider Business Practice Location Address
First Line	:	13243 ITALIAN CYPRESS TRL
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77044-4071
Country	:	US
Telephone Number	:	281-900-8625
Fax Number	:	713-692-2157

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

Provider Enumeration Date	:	08/19/2014
Last Update Date	:	07/17/2020

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Directions to “ JAZMINE MARSHALL ” Practice Location

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