Jasmine Staten

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

P.08569 Issued in OH

Practice address

1010 Valley St
Dayton, OH 45404-2070

Phone

(937) 641-3401

Fax

(937) 641-3046

NPI assigned

Feb 7, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dayton Children'S Hospital

  • Child & Adolescent Psychiatry Physician
  • Dayton, OH
  • NPI 1952480030

  Clinical Child & Adolescent

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1517961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775088000000",
    "number": "1578062261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 933421",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441930039",
            "telephone_number": "937-641-5072",
            "fax_number": "937-641-6129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 VALLEY ST",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454042070",
            "telephone_number": "937-641-3401",
            "fax_number": "937-641-3046"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1425 N Fairfield Rd Ste 220",
            "address_purpose": "LOCATION",
            "city": "Beavercreek",
            "state": "OH",
            "postal_code": "454322673",
            "country_code": "US",
            "telephone_number": "937-320-1950",
            "fax_number": "937-320-9332",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3333 W Tech Rd Ste 220",
            "address_purpose": "LOCATION",
            "city": "Miamisburg",
            "state": "OH",
            "postal_code": "453420956",
            "country_code": "US",
            "telephone_number": "937-748-6116",
            "fax_number": "937-291-6956",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1816 Harvard Blvd Ste 202",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "454064539",
            "country_code": "US",
            "telephone_number": "937-641-3401",
            "fax_number": "937-641-3046",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Childrens Plz",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "454041815",
            "country_code": "US",
            "telephone_number": "937-641-3401",
            "fax_number": "937-641-3046",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5501 Far Hills Ave Ste 200",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "454292203",
            "country_code": "US",
            "telephone_number": "937-436-2866",
            "fax_number": "937-436-1468",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "204 Patrick Ave",
            "address_purpose": "LOCATION",
            "city": "Urbana",
            "state": "OH",
            "postal_code": "430782302",
            "country_code": "US",
            "telephone_number": "937-484-6157",
            "fax_number": "937-484-6181",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1640 N Limestone St",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "OH",
            "postal_code": "455032652",
            "country_code": "US",
            "telephone_number": "937-328-2320",
            "fax_number": "937-328-2349",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9000 N Main St Ste 332",
            "address_purpose": "LOCATION",
            "city": "Englewood",
            "state": "OH",
            "postal_code": "454151185",
            "country_code": "US",
            "telephone_number": "937-832-7337",
            "fax_number": "937-832-4817",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STATEN",
        "first_name": "JASMINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-07",
        "last_updated": "2026-04-02",
        "certification_date": "2026-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "OH",
            "license": "P.08569",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0288064",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carmen C Starks
• William Grant Starrett, MD
• State Health Care LTD
• State of Ohio Department of Mental Health
• Camela Robin Staten, INDEPENDENT PROVIDER
• Mary Elizabeth Staten
• Tashawna Staten, LPN
• Theron C Statler, PTA, LMT
• Taylor Staudt, DPM
• Thomas Stauffer, CDCA

• Clinical Child & Adolescent Psychologist in Dayton, OH
• Providers in Dayton, OH by specialty
• Clinical Child & Adolescent Psychologist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.