Provider Demographics
NPI:1699266700
Name:HENRY-ALA, JASMINE MICHELLE
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:MICHELLE
Last Name:HENRY-ALA
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 1:14735 RATH ST
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-1839
Mailing Address - Country:US
Mailing Address - Phone:310-346-3220
Mailing Address - Fax:
Practice Address - Street 1:14735 RATH ST
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-1839
Practice Address - Country:US
Practice Address - Phone:310-346-3220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105251106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist