MEDICARE: INTEGRATED MENTAL HEALTH CLINIC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1992689996
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED MENTAL HEALTH CLINIC

Provider Business Mailing Address
First Line	:	4014 DIAMONDHEAD AVE
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20721-1308
Country	:	US
Telephone Number	:	202-352-1553
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 N WASHINGTON ST FL 3
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-2398
Country	:	US
Telephone Number	:	703-570-5657
Fax Number	:	703-570-5661

Authorized Official
Title or Position	:	OWNER
Name	:	HENRY JIMENEZ
Credential	:
Telephone Number	:	202-352-1553

Provider Enumeration Date	:	08/04/2025
Last Update Date	:	08/04/2025

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