Basic Information
| Provider Information | |||||||||
| NPI: | 1184398216 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CATHERSON | ||||||||
| FirstName: | JAZMINE | ||||||||
| MiddleName: | ALEXUS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 E ELDORADO PKWY APT 1115 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ELM | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750685384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5754158990 | ||||||||
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| Practice Location | |||||||||
| Address1: | 255 LEBANON RD #212 | ||||||||
| Address2: | |||||||||
| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8557827822 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2021 | ||||||||
| LastUpdateDate: | 08/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.