Basic Information
Provider Information | |||||||||
NPI: | 1831608272 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | JASSO | ||||||||
FirstName: | SYLVIA | ||||||||
MiddleName: | PATRICIA | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 2087 | ||||||||
Address2: |   | ||||||||
City: | MERCED | ||||||||
State: | CA | ||||||||
PostalCode: | 953440087 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2093816800 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1471 B ST STE N | ||||||||
Address2: |   | ||||||||
City: | LIVINGSTON | ||||||||
State: | CA | ||||||||
PostalCode: | 953341426 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2093944032 | ||||||||
FaxNumber: | 2093944166 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/28/2017 | ||||||||
LastUpdateDate: | 03/27/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/27/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X |   |   | Y |   | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
ID | Type | State | Issuer | Description | ASW85410 | 01 | CA | BOARD OF BEHAVIOR SCIENCES | OTHER |