Healthcare Provider Details

I. General information

NPI: 1497034441
Provider Name (Legal Business Name): LYNN ROCHELLE JIMENEZ PCC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2011
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 19TH ST NE
CANTON OH
44714-2213
US

IV. Provider business mailing address

PO BOX 9459
CANTON OH
44711-9459
US

V. Phone/Fax

Practice location:
  • Phone: 330-491-1351
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC0600029
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: