1487316469 NPI number — MRS. PHOENIX NOEL JASMINE LMFT

Table of content: MRS. PHOENIX NOEL JASMINE LMFT (NPI 1487316469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487316469 NPI number — MRS. PHOENIX NOEL JASMINE LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JASMINE
Provider First Name:
PHOENIX
Provider Middle Name:
NOEL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOOK
Provider Other First Name:
PHOENIX
Provider Other Middle Name:
NOEL
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1487316469
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1031 SUSANA CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN MARCOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92078-4629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-807-5301
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2382 FARADAY AVE
Provider Second Line Business Practice Location Address:
SUITE 200- 18
Provider Business Practice Location Address City Name:
CARLSBAD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
442-264-7188
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/07/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  147271 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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