Provider Demographics
NPI:1043961691
Name:BURDEN, JASMINE L (CADC-II)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:L
Last Name:BURDEN
Suffix:
Gender:F
Credentials:CADC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74390 ALESSANDRO DR APT 9
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-3759
Mailing Address - Country:US
Mailing Address - Phone:760-296-6214
Mailing Address - Fax:
Practice Address - Street 1:28321 HORIZON RD
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-3792
Practice Address - Country:US
Practice Address - Phone:442-241-7719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-14
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA061861122101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)