Provider Demographics
NPI:1184921660
Name:JASMINE E. KHAN
Entity type:Organization
Organization Name:JASMINE E. KHAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:254-235-6542
Mailing Address - Street 1:2121 W WACO DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76707-3480
Mailing Address - Country:US
Mailing Address - Phone:254-235-6542
Mailing Address - Fax:254-235-6254
Practice Address - Street 1:2121 W WACO DR
Practice Address - Street 2:SUITE 545
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76707-3480
Practice Address - Country:US
Practice Address - Phone:254-235-6542
Practice Address - Fax:254-235-6254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-18
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34737103T00000X
TX14251101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX027587702Medicaid