MEDICARE: DALISA JIMENEZ

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	LPC-17074	AZ

General Provider Information

NPI Number	:	1407346778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALISA JIMENEZ

Provider Business Mailing Address
First Line	:	15825 S 46TH ST STE 125
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85048-0445
Country	:	US
Telephone Number	:	480-248-5338
Fax Number	:

Provider Business Practice Location Address
First Line	:	15825 S 46TH ST STE 125
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85048-0445
Country	:	US
Telephone Number	:	480-248-5338
Fax Number	:

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

Provider Enumeration Date	:	05/13/2018
Last Update Date	:	02/23/2026

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Directions to “ DALISA JIMENEZ ” Practice Location

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