Provider Demographics
NPI:1932618378
Name:HYDE, JASMINE (BCBA)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:HYDE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7906 COPPER BRK
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-3929
Mailing Address - Country:US
Mailing Address - Phone:210-274-2112
Mailing Address - Fax:
Practice Address - Street 1:7906 COPPER BRK
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109-3929
Practice Address - Country:US
Practice Address - Phone:210-274-2112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-17-27669103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst