Provider Demographics
NPI:1104183722
Name:MARCIA HOUDEK JIMENEZ, PH.D.
Entity Type:Organization
Organization Name:MARCIA HOUDEK JIMENEZ, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:HOUDEK
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:425-488-7347
Mailing Address - Street 1:8301 161ST AVE NE
Mailing Address - Street 2:STE 300
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3858
Mailing Address - Country:US
Mailing Address - Phone:425-885-3330
Mailing Address - Fax:425-702-2474
Practice Address - Street 1:8301 161ST AVE NE
Practice Address - Street 2:STE 300
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3858
Practice Address - Country:US
Practice Address - Phone:425-885-3330
Practice Address - Fax:425-702-2474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA683103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
108953Medicare UPIN