Basic Information
Provider Information
NPI: 1700170131
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TORBET
FirstName: JASMINE
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential: P.C.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 211 BIEDE AVE
Address2:  
City: DEFIANCE
State: OH
PostalCode: 435122408
CountryCode: US
TelephoneNumber: 4197828856
FaxNumber:  
Practice Location
Address1: 211 BIEDE AVE
Address2:  
City: DEFIANCE
State: OH
PostalCode: 435122408
CountryCode: US
TelephoneNumber: 4197828856
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/02/2011
LastUpdateDate: 09/05/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500XC.1000017OHY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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