Healthcare Provider Details

I. General information

NPI: 1902712698
Provider Name (Legal Business Name): JIMENA GAMBOA
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1429 ALANA FALLS AVE
PFLUGERVILLE TX
78660-1176
US

IV. Provider business mailing address

1429 ALANA FALLS AVE
PFLUGERVILLE TX
78660-1176
US

V. Phone/Fax

Practice location:
  • Phone: 956-490-8447
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number102337
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: