Provider Demographics
NPI:1528537354
Name:NIEVES MORALES, JASMINE MERI (MA, RMHCI)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:MERI
Last Name:NIEVES MORALES
Suffix:
Gender:F
Credentials:MA, RMHCI
Other - Prefix:
Other - First Name:JASMINE
Other - Middle Name:MERI
Other - Last Name:NIEVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1718 PENZANCE PKWY
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-3940
Mailing Address - Country:US
Mailing Address - Phone:340-332-8918
Mailing Address - Fax:
Practice Address - Street 1:17356 US HIGHWAY 301 N
Practice Address - Street 2:
Practice Address - City:STARKE
Practice Address - State:FL
Practice Address - Zip Code:32091-1619
Practice Address - Country:US
Practice Address - Phone:904-290-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-22
Last Update Date:2018-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRMHCI15670101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health