Provider Demographics
NPI:1043948649
Name:LACOURSE, JASMIN J
Entity Type:Individual
Prefix:
First Name:JASMIN
Middle Name:J
Last Name:LACOURSE
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 1:7608 NARROW PASS ST
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3019
Mailing Address - Country:US
Mailing Address - Phone:210-338-0063
Mailing Address - Fax:210-579-7115
Practice Address - Street 1:7608 NARROW PASS ST
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3019
Practice Address - Country:US
Practice Address - Phone:210-338-0063
Practice Address - Fax:210-579-7115
Is Sole Proprietor?:No
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-22-228434106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician