MEDICARE: JASMINE GULLEY CDCA

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	171M00000X	Case Manager/Care Coordinator
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	CDCA.189944	OH

General Provider Information

NPI Number	:	1730889569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE GULLEY CDCA

Provider Business Mailing Address
First Line	:	1815 W MARKET ST STE 102
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44313-7018
Country	:	US
Telephone Number	:	234-340-2138
Fax Number	:	330-280-5115

Provider Business Practice Location Address
First Line	:	1815 W MARKET ST STE 102
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44313-7018
Country	:	US
Telephone Number	:	234-340-2138
Fax Number	:	330-280-5115

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

Provider Enumeration Date	:	03/09/2023
Last Update Date	:	01/05/2026

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