Provider Demographics
NPI:1336690270
Name:MALEKAN, JASMINE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:JASMINE
Middle Name:
Last Name:MALEKAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13488 MAXELLA AVE APT 530
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-4318
Mailing Address - Country:US
Mailing Address - Phone:516-241-7208
Mailing Address - Fax:
Practice Address - Street 1:13488 MAXELLA AVE APT 530
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-4318
Practice Address - Country:US
Practice Address - Phone:516-241-7208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-15
Last Update Date:2016-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94545106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist