Provider Demographics
NPI:1033837232
Name:PHILLIPS, JASMINE MONET
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:MONET
Last Name:PHILLIPS
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 1:4534 HARDY BILLUPS RD
Mailing Address - Street 2:
Mailing Address - City:CRAWFORD
Mailing Address - State:MS
Mailing Address - Zip Code:39743-9473
Mailing Address - Country:US
Mailing Address - Phone:662-549-8808
Mailing Address - Fax:
Practice Address - Street 1:4534 HARDY BILLUPS RD
Practice Address - Street 2:
Practice Address - City:CRAWFORD
Practice Address - State:MS
Practice Address - Zip Code:39743-9473
Practice Address - Country:US
Practice Address - Phone:662-549-8808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service