Healthcare Provider Details

I. General information

NPI: 1154735272
Provider Name (Legal Business Name): CHRISTINA GIMENEZ LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 TALL PINES DR STE 220
LARGO FL
33771-5347
US

IV. Provider business mailing address

1808 HIBISCUS CT N
OLDSMAR FL
34677-2720
US

V. Phone/Fax

Practice location:
  • Phone: 727-547-5979
  • Fax:
Mailing address:
  • Phone: 727-742-0472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC014317
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH14772
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: