MEDICARE: LIZBETH JIMENEZ MA. 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	92754	TX

General Provider Information

NPI Number	:	1205625720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIZBETH JIMENEZ MA. LPC

Provider Business Mailing Address
First Line	:	4400 N MIDLAND DR
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79707-3385
Country	:	US
Telephone Number	:	617-379-0496
Fax Number	:

Provider Business Practice Location Address
First Line	:	1406 N GRANDVIEW AVE
Second Line	:
City	:	ODESSA
State	:	TX
Zip	:	79761-3140
Country	:	US
Telephone Number	:	432-220-3273
Fax Number	:

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

Provider Enumeration Date	:	05/01/2025
Last Update Date	:	02/03/2026

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