Provider Demographics
NPI:1073245387
Name:IDROGO, JASMINE VICTORIA (MS, LPC-ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:VICTORIA
Last Name:IDROGO
Suffix:
Gender:F
Credentials:MS, LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11220 W LOOP 1604 N STE 119
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-6600
Mailing Address - Country:US
Mailing Address - Phone:210-956-2922
Mailing Address - Fax:
Practice Address - Street 1:11220 W LOOP 1604 N STE 119
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-6600
Practice Address - Country:US
Practice Address - Phone:210-956-2922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89015101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)