Basic Information
| Provider Information | |||||||||
| NPI: | 1033651286 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | JASSET | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSY.D., LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1881 N UNIVERSITY DR | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330718915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543400888 | ||||||||
| FaxNumber: | 9543460909 | ||||||||
| Practice Location | |||||||||
| Address1: | 1881 N UNIVERSITY DR | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330718915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543400888 | ||||||||
| FaxNumber: | 9543460909 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2016 | ||||||||
| LastUpdateDate: | 12/05/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | MH10274 | FL | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 103T00000X | PY9755 | FL | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.