Healthcare Provider Details

I. General information

NPI: 1609118850
Provider Name (Legal Business Name): AMADA L JIMENEZ PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. AMADA L STRANGE

II. Dates (important events)

Enumeration Date: 03/25/2013
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1292 HIGH ST # 1176
EUGENE OR
97401-3238
US

IV. Provider business mailing address

1292 HIGH ST # 1176
EUGENE OR
97401-3238
US

V. Phone/Fax

Practice location:
  • Phone: 541-631-0848
  • Fax:
Mailing address:
  • Phone: 541-631-0848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3316
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: