Provider Demographics
NPI:1972002723
Name:BANAFSHE, JASMINE J (LPC)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:J
Last Name:BANAFSHE
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 1:11314 HUBBARD ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-2764
Mailing Address - Country:US
Mailing Address - Phone:480-415-3271
Mailing Address - Fax:
Practice Address - Street 1:2901 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-8548
Practice Address - Country:US
Practice Address - Phone:517-548-1537
Practice Address - Fax:517-548-9399
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI640104841101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional