Provider Demographics
NPI:1295953263
Name:ORTIZ, JASMINE (MFT-I)
Entity type:Individual
Prefix:MS
First Name:JASMINE
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:MFT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 GRAYSON RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2604
Mailing Address - Country:US
Mailing Address - Phone:925-935-2740
Mailing Address - Fax:
Practice Address - Street 1:808 GRAYSON RD
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2604
Practice Address - Country:US
Practice Address - Phone:825-935-2740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA143363106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist