Provider Demographics
NPI:1033735477
Name:WALDON, JASMINE REYNA
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:REYNA
Last Name:WALDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 ANCESTRY LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75217-7777
Mailing Address - Country:US
Mailing Address - Phone:214-883-9577
Mailing Address - Fax:
Practice Address - Street 1:3218 INTERSTATE 30 STE 103
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-2666
Practice Address - Country:US
Practice Address - Phone:945-238-3163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86377101YP2500X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor