Healthcare Provider Details

I. General information

NPI: 1801595038
Provider Name (Legal Business Name): CRISTINA JIMENEZ LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3514 STELLHORN RD
FORT WAYNE IN
46815-4631
US

IV. Provider business mailing address

953 BUCHANAN ST
FORT WAYNE IN
46803-4005
US

V. Phone/Fax

Practice location:
  • Phone: 260-310-5471
  • Fax: 317-759-7299
Mailing address:
  • Phone: 260-310-5471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number39005804A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: