Provider Demographics
NPI:1497421093
Name:WELCH, JAZMINE ALEXANDRIA (LCSW)
Entity type:Individual
Prefix:
First Name:JAZMINE
Middle Name:ALEXANDRIA
Last Name:WELCH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JAZMINE
Other - Middle Name:ALEXANDRIA
Other - Last Name:BUREL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ASCW
Mailing Address - Street 1:1481 WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-5416
Mailing Address - Country:US
Mailing Address - Phone:909-361-6470
Mailing Address - Fax:909-203-7403
Practice Address - Street 1:1481 WINDSOR DR
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-5416
Practice Address - Country:US
Practice Address - Phone:909-361-6470
Practice Address - Fax:909-203-7403
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95209101YM0800X
CA1201021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health