Provider Demographics
NPI:1467113894
Name:JIMENEZ, ODILIA (LPC)
Entity Type:Individual
Prefix:
First Name:ODILIA
Middle Name:
Last Name:JIMENEZ
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 1:2782 MEADOW BRK
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-4205
Mailing Address - Country:US
Mailing Address - Phone:956-295-6944
Mailing Address - Fax:
Practice Address - Street 1:2782 MEADOW BRK
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-4205
Practice Address - Country:US
Practice Address - Phone:956-295-6944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80723101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health