Provider Demographics
NPI:1982283784
Name:LEE, JASMINE R (RBT)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:R
Last Name:LEE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:JASMINE
Other - Middle Name:R
Other - Last Name:CALLIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:1947 LARKSPUR DR APT 402
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-4949
Mailing Address - Country:US
Mailing Address - Phone:252-281-8080
Mailing Address - Fax:
Practice Address - Street 1:14235 BLANCO RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-7718
Practice Address - Country:US
Practice Address - Phone:210-415-9626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-21-162843106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician