Provider Demographics
NPI:1346746542
Name:JAIMEZ, ACACIA DEAL (LPC)
Entity Type:Individual
Prefix:
First Name:ACACIA
Middle Name:DEAL
Last Name:JAIMEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 GRANADA DR
Mailing Address - Street 2:
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-3134
Mailing Address - Country:US
Mailing Address - Phone:210-875-4445
Mailing Address - Fax:
Practice Address - Street 1:11901 TOEPPERWEIN RD STE 901
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3158
Practice Address - Country:US
Practice Address - Phone:210-875-4445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75441101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional