Provider Demographics
NPI:1013717073
Name:MARTIN, JASMINE LASHAYE
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:LASHAYE
Last Name:MARTIN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4684 SAINT ANTOINE ST APT 104
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-1959
Mailing Address - Country:US
Mailing Address - Phone:947-800-9449
Mailing Address - Fax:
Practice Address - Street 1:4684 SAINT ANTOINE ST APT 104
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1959
Practice Address - Country:US
Practice Address - Phone:947-800-9449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician