Provider Demographics
NPI:1316559602
Name:SMITH, JASMINE E (BCBA)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:E
Last Name:SMITH
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 W GREYHOUND PASS
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-7003
Mailing Address - Country:US
Mailing Address - Phone:317-403-6705
Mailing Address - Fax:
Practice Address - Street 1:148 W GREYHOUND PASS
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-7003
Practice Address - Country:US
Practice Address - Phone:317-403-6705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-20-43465103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst