Healthcare Provider Details

I. General information

NPI: 1326558271
Provider Name (Legal Business Name): LILIANA JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2017
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 S 400 E
SALT LAKE CITY UT
84111-2905
US

IV. Provider business mailing address

689 CROWN ROSE DR
BARTOW FL
33830-6362
US

V. Phone/Fax

Practice location:
  • Phone: 801-582-5534
  • Fax: 801-582-5540
Mailing address:
  • Phone: 417-365-2422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

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: