MEDICARE: JIMIA STOKES LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	85013	TX
2	101YP2500X	Professional Counselor	178012538	IL

General Provider Information

NPI Number	:	1174064026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIMIA STOKES LPC

Provider Business Mailing Address
First Line	:	6125 AMELIA AVE APT 2319
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-2420
Country	:	US
Telephone Number	:	708-439-5386
Fax Number	:

Provider Business Practice Location Address
First Line	:	6125 AMELIA AVE APT 2319
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-2420
Country	:	US
Telephone Number	:	708-439-5386
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2017
Last Update Date	:	01/15/2021

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Directions to “ JIMIA STOKES LPC” Practice Location

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