MEDICARE: JASMINE CLUSTER

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	13977524-6009	UT

General Provider Information

NPI Number	:	1407718307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE CLUSTER

Provider Business Mailing Address
First Line	:	2642 N 500 E
Second Line	:
City	:	NORTH OGDEN
State	:	UT
Zip	:	84414-2307
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1133 N MAIN ST STE 100
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-4868
Country	:	US
Telephone Number	:	801-882-7387
Fax Number	:

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

Provider Enumeration Date	:	11/29/2025
Last Update Date	:	11/29/2025

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Directions to “ JASMINE CLUSTER ” Practice Location

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