Provider Demographics
NPI:1356714794
Name:BETTIES, JASMINE SIMONE (MS)
Entity type:Individual
Prefix:MS
First Name:JASMINE
Middle Name:SIMONE
Last Name:BETTIES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2652 JUNIPER AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-2630
Mailing Address - Country:US
Mailing Address - Phone:706-992-4193
Mailing Address - Fax:
Practice Address - Street 1:2652 JUNIPER AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-2630
Practice Address - Country:US
Practice Address - Phone:706-992-4193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker