Provider Demographics
NPI:1417796673
Name:SNELICK, JASMINE BERNADETTE
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:BERNADETTE
Last Name:SNELICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 EDMONTON DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-2950
Mailing Address - Country:US
Mailing Address - Phone:972-804-2329
Mailing Address - Fax:
Practice Address - Street 1:4917 GOLDEN TRIANGLE BLVD STE 411
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-4672
Practice Address - Country:US
Practice Address - Phone:817-754-4940
Practice Address - Fax:817-717-8584
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician