Provider Demographics
NPI:1053813543
Name:JAIME L JASSER
Entity Type:Organization
Organization Name:JAIME L JASSER
Other - Org Name:JAIME JASSER, PHD LMHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GROUP PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:JASSER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMHC
Authorized Official - Phone:352-222-9278
Mailing Address - Street 1:2240 NW 40TH TERRACE STE A
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605
Mailing Address - Country:US
Mailing Address - Phone:352-222-9278
Mailing Address - Fax:352-378-7849
Practice Address - Street 1:2240 NW 40TH TERRACE STE A
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605
Practice Address - Country:US
Practice Address - Phone:352-222-9278
Practice Address - Fax:352-378-7849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty