Healthcare Provider Details

I. General information

NPI: 1871760801
Provider Name (Legal Business Name): ARELY JIMENEZ LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 S MAIN ST #D203
COUPEVILLE WA
98239-3541
US

IV. Provider business mailing address

107 S MAIN ST #D203
COUPEVILLE WA
98239-3541
US

V. Phone/Fax

Practice location:
  • Phone: 360-678-5840
  • Fax: 360-678-1400
Mailing address:
  • Phone: 360-678-5840
  • Fax: 360-678-1400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF 00002661
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: