Provider Demographics
NPI:1720207111
Name:JIMENEZ, DANTE (LPC-S, NCC)
Entity Type:Individual
Prefix:
First Name:DANTE
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:LPC-S, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2229 TIERRA ROBLES DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-4406
Mailing Address - Country:US
Mailing Address - Phone:915-274-3166
Mailing Address - Fax:
Practice Address - Street 1:6090 SURETY DR STE 200
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2041
Practice Address - Country:US
Practice Address - Phone:915-781-1337
Practice Address - Fax:915-881-4959
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20243101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1797169-01OtherMEDICAID--TPI (PERSONAL)
TX1797169-02OtherMEDICAID--TPI (EPMHMR)
TX1797169-01OtherMEDICAID--TPI (PERSONAL)