MEDICARE: SUSANA JIMENEZ LPC-A

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	89770	TX

General Provider Information

NPI Number	:	1639893902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSANA JIMENEZ LPC-A

Provider Business Mailing Address
First Line	:	4801 WOODWAY DR STE 306W
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056-1828
Country	:	US
Telephone Number	:	832-225-3345
Fax Number	:	713-583-1504

Provider Business Practice Location Address
First Line	:	4801 WOODWAY DR STE 306W
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056-1828
Country	:	US
Telephone Number	:	832-225-3345
Fax Number	:	713-583-1504

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

Provider Enumeration Date	:	09/30/2022
Last Update Date	:	09/30/2022

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Directions to “ SUSANA JIMENEZ LPC-A” Practice Location

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