Provider Demographics
NPI:1376520411
Name:JIMENEZ, NELLIE (MED, LPCI)
Entity Type:Individual
Prefix:
First Name:NELLIE
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:MED, LPCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6021 MORRISS RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-3710
Mailing Address - Country:US
Mailing Address - Phone:469-635-2200
Mailing Address - Fax:972-874-0523
Practice Address - Street 1:6021 MORRISS RD
Practice Address - Street 2:SUITE 112
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-3710
Practice Address - Country:US
Practice Address - Phone:469-635-2200
Practice Address - Fax:972-874-0523
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60228101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional