Provider Demographics
NPI:1255887295
Name:MILLER, JASMINE BOARD (DMFT LMFT)
Entity type:Individual
Prefix:DR
First Name:JASMINE
Middle Name:BOARD
Last Name:MILLER
Suffix:
Gender:F
Credentials:DMFT LMFT
Other - Prefix:
Other - First Name:JASMINE
Other - Middle Name:B
Other - Last Name:BOARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMFT LMFT
Mailing Address - Street 1:PO BOX 79425
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92877-0180
Mailing Address - Country:US
Mailing Address - Phone:310-617-9306
Mailing Address - Fax:
Practice Address - Street 1:3610 CENTRAL AVE STE 500
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-5907
Practice Address - Country:US
Practice Address - Phone:951-550-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89929106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist