Provider Demographics
NPI:1538720164
Name:BRAZLE, JAZMINE BRIANNA (LPC)
Entity type:Individual
Prefix:
First Name:JAZMINE
Middle Name:BRIANNA
Last Name:BRAZLE
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 1:8181 EL MUNDO ST APT 1402
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-4156
Mailing Address - Country:US
Mailing Address - Phone:713-443-5717
Mailing Address - Fax:
Practice Address - Street 1:8181 EL MUNDO ST APT 1402
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-4156
Practice Address - Country:US
Practice Address - Phone:713-443-5717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-25
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77495101Y00000X, 101YP2500X, 101YM0800X
77495101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty