MEDICARE: MR. GILL WAYNE JASMINE JR. LPC

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	8488	LA
2	101YP2500X	Professional Counselor
3	171M00000X	Case Manager/Care Coordinator
4	101YP2500X	Professional Counselor	PC018919	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194343723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GILL WAYNE JASMINE JR. LPC

Provider Business Mailing Address
First Line	:	1415 N 31ST ST APT 309
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19121-3641
Country	:	US
Telephone Number	:	985-817-5705
Fax Number	:

Provider Business Practice Location Address
First Line	:	1415 N 31ST ST APT 309
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19121-3641
Country	:	US
Telephone Number	:	985-817-5705
Fax Number	:

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

Provider Enumeration Date	:	07/09/2020
Last Update Date	:	03/12/2026

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