Provider Demographics
NPI:1609007343
Name:MOORE, JASMINE PEREZ (MA)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:PEREZ
Last Name:MOORE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 545
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85252-0545
Mailing Address - Country:US
Mailing Address - Phone:602-909-8409
Mailing Address - Fax:480-237-9643
Practice Address - Street 1:3420 E SHEA BLVD
Practice Address - Street 2:#200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3345
Practice Address - Country:US
Practice Address - Phone:602-909-8409
Practice Address - Fax:480-237-9643
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-13258101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional