Provider Demographics
NPI:1871276766
Name:OLMSTEAD, JASMINE (LCSW)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:OLMSTEAD
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 SUMMERS PL
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74604-4443
Mailing Address - Country:US
Mailing Address - Phone:406-998-8390
Mailing Address - Fax:
Practice Address - Street 1:1300 SUMMERS PL
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74604-4443
Practice Address - Country:US
Practice Address - Phone:406-998-8390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTEBH-LCSW-LIC-643901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical