Provider Demographics
NPI:1437358686
Name:KHAN, JASMINE ERNA (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:JASMINE
Middle Name:ERNA
Last Name:KHAN
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 W WACO DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76707-3480
Mailing Address - Country:US
Mailing Address - Phone:254-235-6542
Mailing Address - Fax:
Practice Address - Street 1:2121 W WACO DR
Practice Address - Street 2:SUITE 545
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76707-3480
Practice Address - Country:US
Practice Address - Phone:254-235-6542
Practice Address - Fax:254-235-6254
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14251101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2199595001Medicaid
TX027587702Medicaid