Provider Demographics
NPI:1861205494
Name:SIMON, JASMINE (LMSW)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 KIRKMAN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70607-4603
Mailing Address - Country:US
Mailing Address - Phone:337-475-3100
Mailing Address - Fax:
Practice Address - Street 1:437 N MARKET ST
Practice Address - Street 2:
Practice Address - City:JENNINGS
Practice Address - State:LA
Practice Address - Zip Code:70546-5857
Practice Address - Country:US
Practice Address - Phone:337-246-7325
Practice Address - Fax:337-246-7328
Is Sole Proprietor?:No
Enumeration Date:2025-01-28
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA18411104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker