Provider Demographics
NPI:1376019661
Name:MITCHELL, JASMINE R (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:R
Last Name:MITCHELL
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 1:4502 RIVERSTONE BLVD STE 701
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-5213
Mailing Address - Country:US
Mailing Address - Phone:281-969-7527
Mailing Address - Fax:
Practice Address - Street 1:4502 RIVERSTONE BLVD STE 1001
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-5209
Practice Address - Country:US
Practice Address - Phone:832-987-1687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2542103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst