Provider Demographics
NPI:1548518079
Name:BLUE, JASMINE DOMINIQUE (LPC)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:DOMINIQUE
Last Name:BLUE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15818 WHITEGLADE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-6800
Mailing Address - Country:US
Mailing Address - Phone:713-539-5727
Mailing Address - Fax:
Practice Address - Street 1:501 MURPHY RD STE 400
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-5417
Practice Address - Country:US
Practice Address - Phone:281-969-8040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68068101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional