Provider Demographics
NPI:1922515212
Name:HUNTLEY, JASMEN ORALIA
Entity Type:Individual
Prefix:MRS
First Name:JASMEN
Middle Name:ORALIA
Last Name:HUNTLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JASMEN
Other - Middle Name:ORALIA
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1050 LAKE FRONT DR APT 926
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-5638
Mailing Address - Country:US
Mailing Address - Phone:916-509-1845
Mailing Address - Fax:
Practice Address - Street 1:4540 HARLIN DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-9716
Practice Address - Country:US
Practice Address - Phone:909-484-2848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1729249106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician