Provider Demographics
NPI:1699412155
Name:JIMENEZ, ALEXIS (PSYD, LCP)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:PSYD, LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 SPRINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-8993
Mailing Address - Country:US
Mailing Address - Phone:773-680-2111
Mailing Address - Fax:
Practice Address - Street 1:621 SPRINGWOOD DR
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-8993
Practice Address - Country:US
Practice Address - Phone:773-680-2111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009726103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical