Provider Demographics
NPI:1740807999
Name:USSERY, JASMINE (MA, BCBA)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:USSERY
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 453
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:IN
Mailing Address - Zip Code:47610-0453
Mailing Address - Country:US
Mailing Address - Phone:678-235-8805
Mailing Address - Fax:
Practice Address - Street 1:1455 OLD ALABAMA RD STE 195
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-2129
Practice Address - Country:US
Practice Address - Phone:678-940-1367
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2020-07-02
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-20-41530103K00000X
IN1-20-41530103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst