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General NPI Number Information
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NPI Number | 1992892467
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Entity Type | Individual
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Provider Name | GEORGIA SUE JIMENEZ L.S.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 415 N POPLAR AVE
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City | WICHITA
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State | KS
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Zip | 67214-4529
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Country | US
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Telephone | 316-686-6671
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Fax |
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Provider Business Mailing Address
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Address Line | 4103 N TARA CIR
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City | WICHITA
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State | KS
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Zip | 67226-3302
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Country | US
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Telephone | 316-634-6480
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2396
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License Number State | KS
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