Provider Demographics
NPI:1548435233
Name:CAMACHO, JASMINE
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:CAMACHO
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 1:701 S 48TH AVE
Mailing Address - Street 2:APT L-7
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3648
Mailing Address - Country:US
Mailing Address - Phone:509-594-8988
Mailing Address - Fax:
Practice Address - Street 1:701 S 48TH AVE
Practice Address - Street 2:APT L-7
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3648
Practice Address - Country:US
Practice Address - Phone:509-594-8988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101Y00000X
WARC60019307171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor