Provider Demographics
NPI:1801209507
Name:MENSER-LUST, JASMINE (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:JASMINE
Middle Name:
Last Name:MENSER-LUST
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:JASMINE
Other - Middle Name:
Other - Last Name:MENSER-LUST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:1010 JORIE BLVD
Mailing Address - Street 2:112
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2215
Mailing Address - Country:US
Mailing Address - Phone:224-325-4513
Mailing Address - Fax:
Practice Address - Street 1:1010 JORIE BLVD
Practice Address - Street 2:112
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-2215
Practice Address - Country:US
Practice Address - Phone:224-325-4513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178010019101YP2500X
IL180010851101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional