Provider Demographics
NPI:1366151714
Name:STANLEY, JASMIN T (BCBA)
Entity type:Individual
Prefix:
First Name:JASMIN
Middle Name:T
Last Name:STANLEY
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 1:113 LAWTON ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649-3027
Mailing Address - Country:US
Mailing Address - Phone:864-981-1812
Mailing Address - Fax:
Practice Address - Street 1:113 LAWTON ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649-3027
Practice Address - Country:US
Practice Address - Phone:864-981-1812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1-22-61321103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst