Provider Demographics
NPI:1326511270
Name:BORST, JAZMIN BROOK (ASW)
Entity Type:Individual
Prefix:MRS
First Name:JAZMIN
Middle Name:BROOK
Last Name:BORST
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16805 SAINT GEORGE WAY
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92551-7427
Mailing Address - Country:US
Mailing Address - Phone:402-560-9838
Mailing Address - Fax:
Practice Address - Street 1:16805 SAINT GEORGE WAY
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92551-7427
Practice Address - Country:US
Practice Address - Phone:402-560-9838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA858881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical