Healthcare Provider Details

I. General information

NPI: 1326794777
Provider Name (Legal Business Name): YOUSY JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2022
Last Update Date: 02/24/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22790 SW 112TH AVE
MIAMI FL
33170-7602
US

IV. Provider business mailing address

1182 SW 140TH PL
MIAMI FL
33184-2790
US

V. Phone/Fax

Practice location:
  • Phone: 305-235-2616
  • Fax:
Mailing address:
  • Phone: 786-261-7627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH20393
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: