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General NPI Number Information
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NPI Number | 1356943146
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Entity Type | Organization
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Legal Business Name | MICHELLE JIMENEZ
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Dates
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Enumeration Date | 11/16/2020
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Last Update Date | 11/20/2020
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Provider Practice Location Address
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Address Line | 12821 NEWPORT AVE
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City | TUSTIN
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State | CA
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Zip | 92780-2711
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Country | US
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Telephone | 562-537-1905
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Fax | 714-333-4840
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Provider Business Mailing Address
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Address Line | 12821 NEWPORT AVE
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City | TUSTIN
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State | CA
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Zip | 92780-2711
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Country | US
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Telephone | 562-537-1905
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Fax | 714-333-4840
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Authorized Official
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Title or Position | OWNER
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Name | MICHELLE L JIMENEZ
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Credential | LMFT
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Telephone | 562-537-1905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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