Provider Demographics
NPI:1811596109
Name:JIMENEZ, LUISA (PSYD)
Entity Type:Individual
Prefix:
First Name:LUISA
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 CLEVELAND AVE UNIT 501E
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76706-1322
Mailing Address - Country:US
Mailing Address - Phone:919-815-1370
Mailing Address - Fax:
Practice Address - Street 1:1901 VETERANS MEMORIAL DR.
Practice Address - Street 2:BUILDING 202, ROOM 2C264
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504
Practice Address - Country:US
Practice Address - Phone:254-743-2867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist