Provider Demographics
NPI:1235780958
Name:MEREDITH, JASMINE ALESIA (LCDC III)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:ALESIA
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:LCDC III
Other - Prefix:
Other - First Name:JASMINE
Other - Middle Name:ALESIA
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCDC III
Mailing Address - Street 1:5637 WEATHERBY LOOP
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-1238
Mailing Address - Country:US
Mailing Address - Phone:614-327-0535
Mailing Address - Fax:
Practice Address - Street 1:2323 LAKE CLUB DR STE 204
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-3198
Practice Address - Country:US
Practice Address - Phone:614-604-8573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCDCIII.162224101YA0400X
OH171M00000X
OHM.2300328-TRNE106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care Coordinator