Provider Demographics
NPI:1174119358
Name:TERRY, JASMINE E (ACSW)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:E
Last Name:TERRY
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 W 190TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-4235
Mailing Address - Country:US
Mailing Address - Phone:562-306-2925
Mailing Address - Fax:
Practice Address - Street 1:20620 ANZA AVE APT 23
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-2970
Practice Address - Country:US
Practice Address - Phone:323-327-1384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-12
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW85645104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty