Provider Demographics
NPI:1679337513
Name:JUSTUS, JASMINE (MED, BCBA, LBA-OK)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:JUSTUS
Suffix:
Gender:F
Credentials:MED, BCBA, LBA-OK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 SW 154TH PL
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-7538
Mailing Address - Country:US
Mailing Address - Phone:405-395-7929
Mailing Address - Fax:
Practice Address - Street 1:612 SW 154TH PL
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-7538
Practice Address - Country:US
Practice Address - Phone:405-395-7929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1-21-54629103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst