Provider Demographics
NPI:1689217515
Name:GIBSON, JASMINE NICOLE (LMFT)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:NICOLE
Last Name:GIBSON
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 1:2716 OCEAN PARK BLVD STE 3075
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-5232
Mailing Address - Country:US
Mailing Address - Phone:424-291-2351
Mailing Address - Fax:
Practice Address - Street 1:2716 OCEAN PARK BLVD STE 3075
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-5232
Practice Address - Country:US
Practice Address - Phone:424-291-2351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT115016106H00000X
CA115016106H00000X
CALMFT133568106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist