Provider Demographics
NPI:1811471733
Name:MINTON, JASMINE DESIREE MCBRIDE (LMFT)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:DESIREE MCBRIDE
Last Name:MINTON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 ROLAND WAY STE 150
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94621-2027
Mailing Address - Country:US
Mailing Address - Phone:510-839-3800
Mailing Address - Fax:
Practice Address - Street 1:401 ROLAND WAY STE 150
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94621-2027
Practice Address - Country:US
Practice Address - Phone:510-839-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-17
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT94784106H00000X
CAAMFT135298106H00000X, 390200000X
CA94784390200000X
CALMFT148548106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program