Provider Demographics
NPI:1760876809
Name:JIMENEZ, ELAINE IRIS (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:IRIS
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:IRIS
Other - Last Name:COLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED INTERN
Mailing Address - Street 1:1644 LUDINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-7603
Mailing Address - Country:US
Mailing Address - Phone:813-368-3052
Mailing Address - Fax:
Practice Address - Street 1:1515 MICHELIN CT
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-7533
Practice Address - Country:US
Practice Address - Phone:813-949-8946
Practice Address - Fax:813-949-2926
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-26
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH17287OtherFDOH
FLJ552209689550OtherDRIVER'S LICENSE