MEDICARE: MISS LYNN ROCHELLE JIMENEZ PCC-S

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	C0600029	OH

General Provider Information

NPI Number	:	1497034441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LYNN ROCHELLE JIMENEZ PCC-S

Provider Business Mailing Address
First Line	:	PO BOX 9459
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44711-9459
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	720 19TH ST NE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44714-2213
Country	:	US
Telephone Number	:	330-491-1351
Fax Number	:

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

Provider Enumeration Date	:	08/09/2011
Last Update Date	:	09/07/2016

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