Provider Demographics
NPI:1558016683
Name:GARBACK, JASMINE RENEE (BT)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:RENEE
Last Name:GARBACK
Suffix:
Gender:F
Credentials:BT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2549 JOLLY RD STE 380
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3680
Mailing Address - Country:US
Mailing Address - Phone:517-300-6950
Mailing Address - Fax:
Practice Address - Street 1:2549 JOLLY RD
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3678
Practice Address - Country:US
Practice Address - Phone:517-300-6950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst