Provider Demographics
NPI:1639893902
Name:JIMENEZ, SUSANA (LPC-A)
Entity Type:Individual
Prefix:
First Name:SUSANA
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 WOODWAY DR STE 306W
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-1828
Mailing Address - Country:US
Mailing Address - Phone:832-225-3345
Mailing Address - Fax:713-583-1504
Practice Address - Street 1:4801 WOODWAY DR STE 306W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-1828
Practice Address - Country:US
Practice Address - Phone:832-225-3345
Practice Address - Fax:713-583-1504
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89770101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional