Healthcare Provider Details

I. General information

NPI: 1699608745
Provider Name (Legal Business Name): MICHELLE MIROSLAVA JIMENEZ DAVILA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 E 32ND ST STE 200
AUSTIN TX
78705-2714
US

IV. Provider business mailing address

4700 N CAPITAL OF TEXAS HWY APT 221
AUSTIN TX
78746-1128
US

V. Phone/Fax

Practice location:
  • Phone: 512-478-4939
  • Fax:
Mailing address:
  • Phone: 512-502-4198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number111388
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: