Provider Demographics
NPI:1538484282
Name:JIMENEZ, ALBERT A (LCDC, CART)
Entity Type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:A
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:LCDC, CART
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 828
Mailing Address - Street 2:
Mailing Address - City:CASTROVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78009
Mailing Address - Country:US
Mailing Address - Phone:210-619-6020
Mailing Address - Fax:
Practice Address - Street 1:5203 OLD PEARSALL RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78242
Practice Address - Country:US
Practice Address - Phone:210-277-7799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9995101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)