Provider Demographics
NPI:1912333436
Name:VAN ANTWERP, JASMINE MARIE (MS, LCPC)
Entity Type:Individual
Prefix:MRS
First Name:JASMINE
Middle Name:MARIE
Last Name:VAN ANTWERP
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 W MENDENHALL ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-3479
Mailing Address - Country:US
Mailing Address - Phone:406-580-2243
Mailing Address - Fax:
Practice Address - Street 1:313 W MENDENHALL ST
Practice Address - Street 2:SUITE 10
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3479
Practice Address - Country:US
Practice Address - Phone:406-580-2243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4679101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional