Provider Demographics
NPI:1578885943
Name:ISAZA, JIMENA (MA, LPC)
Entity Type:Individual
Prefix:
First Name:JIMENA
Middle Name:
Last Name:ISAZA
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2219 SAWDUST RD STE 1101
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2575
Mailing Address - Country:US
Mailing Address - Phone:832-671-6616
Mailing Address - Fax:
Practice Address - Street 1:2219 SAWDUST RD STE 1101
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-2575
Practice Address - Country:US
Practice Address - Phone:832-671-6616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66047101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional