Provider Demographics
NPI:1518053602
Name:JIMENEZ, DARLENE DOROTHEA (LPC RNC LCDC)
Entity Type:Individual
Prefix:MRS
First Name:DARLENE
Middle Name:DOROTHEA
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:LPC RNC LCDC
Other - Prefix:
Other - First Name:DARLENE
Other - Middle Name:DOROTHEA
Other - Last Name:MAYO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3031 W IH 10
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-5159
Mailing Address - Country:US
Mailing Address - Phone:210-261-1000
Mailing Address - Fax:210-731-8678
Practice Address - Street 1:3031 W IH 10
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-5159
Practice Address - Country:US
Practice Address - Phone:210-261-1000
Practice Address - Fax:210-731-8678
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5412101YM0800X
TX13092101YP2500X
TX447244163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX026955701Medicaid