MEDICARE: JASMIN T STANLEY 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	1-22-61321	SC

General Provider Information

NPI Number	:	1366151714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMIN T STANLEY BCBA

Provider Business Mailing Address
First Line	:	113 LAWTON ST
Second Line	:
City	:	GREENWOOD
State	:	SC
Zip	:	29649-3027
Country	:	US
Telephone Number	:	864-981-1812
Fax Number	:

Provider Business Practice Location Address
First Line	:	113 LAWTON ST
Second Line	:
City	:	GREENWOOD
State	:	SC
Zip	:	29649-3027
Country	:	US
Telephone Number	:	864-981-1812
Fax Number	:

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

Provider Enumeration Date	:	11/15/2022
Last Update Date	:	11/15/2022

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