Provider Demographics
NPI:1336671957
Name:COTTA, JASMINE SAAD (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:SAAD
Last Name:COTTA
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1352 IRVINE BLVD
Mailing Address - Street 2:SUITES 102-104
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3549
Mailing Address - Country:US
Mailing Address - Phone:657-204-2639
Mailing Address - Fax:
Practice Address - Street 1:1352 IRVINE BLVD
Practice Address - Street 2:SUITES 102-104
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3549
Practice Address - Country:US
Practice Address - Phone:657-204-2639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF97040106H00000X
CALMFT121518106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist