Provider Demographics
NPI:1104629344
Name:BEVENS, JASMINE BRIEANN (LPC/MHSP)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:BRIEANN
Last Name:BEVENS
Suffix:
Gender:
Credentials:LPC/MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 BIG HILL RD
Mailing Address - Street 2:
Mailing Address - City:MOORESBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37811-5314
Mailing Address - Country:US
Mailing Address - Phone:423-231-4161
Mailing Address - Fax:
Practice Address - Street 1:1536 BRIDGEWATER LN STE 103
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4103
Practice Address - Country:US
Practice Address - Phone:423-343-5665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7810101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health