Provider Demographics
NPI:1518482124
Name:MIAH, JASMEEN (LMFT)
Entity Type:Individual
Prefix:
First Name:JASMEEN
Middle Name:
Last Name:MIAH
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 1:147 S RIVER ST STE 204
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-4540
Mailing Address - Country:US
Mailing Address - Phone:831-471-7400
Mailing Address - Fax:831-603-0345
Practice Address - Street 1:147 S RIVER ST STE 204
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4540
Practice Address - Country:US
Practice Address - Phone:831-471-7400
Practice Address - Fax:831-603-0345
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-04
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA132057106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist