Provider Demographics
NPI:1396468179
Name:WILSON, JASMINE (LMHC, MT-BC)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:LMHC, MT-BC
Other - Prefix:
Other - First Name:JASMINE
Other - Middle Name:
Other - Last Name:TILDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 NICKERSON ST STE 204
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-1634
Mailing Address - Country:US
Mailing Address - Phone:619-693-2586
Mailing Address - Fax:
Practice Address - Street 1:150 NICKERSON ST STE 204
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-1634
Practice Address - Country:US
Practice Address - Phone:619-693-2586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12956225A00000X
WALH61596242101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist