Provider Demographics
NPI:1336305655
Name:JIMENEZ, JUAN DAVID (NCC LMHC)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:DAVID
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:NCC LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 MILLENIA BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839
Mailing Address - Country:US
Mailing Address - Phone:407-924-2399
Mailing Address - Fax:407-240-8570
Practice Address - Street 1:4700 MILLENIA BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839
Practice Address - Country:US
Practice Address - Phone:407-924-2399
Practice Address - Fax:407-240-8570
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6613101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health