Provider Demographics
NPI:1376909762
Name:CIMO, ALEXANDRIA (LPC)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRIA
Middle Name:
Last Name:CIMO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ALLY
Other - Middle Name:
Other - Last Name:CIMO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:101 CANYON LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:TX
Mailing Address - Zip Code:77657-3701
Mailing Address - Country:US
Mailing Address - Phone:409-210-7210
Mailing Address - Fax:
Practice Address - Street 1:101 CANYON LAKE CIR
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:TX
Practice Address - Zip Code:77657-3701
Practice Address - Country:US
Practice Address - Phone:409-210-7210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-14
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5721101YP2500X
TX75260101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional