Provider Demographics
NPI:1700486321
Name:TYREE, JASMIN JETIE (MHS-C , LBS)
Entity Type:Individual
Prefix:
First Name:JASMIN
Middle Name:JETIE
Last Name:TYREE
Suffix:
Gender:F
Credentials:MHS-C , LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 S 63RD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-2929
Mailing Address - Country:US
Mailing Address - Phone:215-913-3874
Mailing Address - Fax:
Practice Address - Street 1:109 S 63RD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-2929
Practice Address - Country:US
Practice Address - Phone:215-913-3874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-01
Last Update Date:2021-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst