Provider Demographics
NPI:1306411533
Name:TATE, JASMINE (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:TATE
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2623
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-2623
Mailing Address - Country:US
Mailing Address - Phone:985-687-1118
Mailing Address - Fax:
Practice Address - Street 1:21 INDUSTRIAL PARK BLVD BLDG A
Practice Address - Street 2:
Practice Address - City:PONCHATOULA
Practice Address - State:LA
Practice Address - Zip Code:70454-8303
Practice Address - Country:US
Practice Address - Phone:985-370-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA541103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst