Provider Demographics
NPI:1467660381
Name:BASCOMBE, JASMINE V (LMFT, CAP)
Entity Type:Individual
Prefix:MS
First Name:JASMINE
Middle Name:V
Last Name:BASCOMBE
Suffix:
Gender:F
Credentials:LMFT, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 NW 31ST AVE
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-6653
Mailing Address - Country:US
Mailing Address - Phone:954-357-5082
Mailing Address - Fax:
Practice Address - Street 1:900 NW 31ST AVE
Practice Address - Street 2:SUITE 2000
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-6653
Practice Address - Country:US
Practice Address - Phone:954-357-5082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1807101YA0400X
FLMT1649106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist