Provider Demographics
NPI:1679045074
Name:JIMENEZ-THOMAS, HAILEE
Entity Type:Individual
Prefix:
First Name:HAILEE
Middle Name:
Last Name:JIMENEZ-THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19730 64TH AVE W STE 314
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5957
Mailing Address - Country:US
Mailing Address - Phone:425-272-9969
Mailing Address - Fax:
Practice Address - Street 1:19730 64TH AVE W STE 314
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5957
Practice Address - Country:US
Practice Address - Phone:425-272-9969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-23
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60982440101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health