Provider Demographics
NPI:1871241307
Name:JIMENEZ-CASSAN, PRISHNA (LPC-A)
Entity Type:Individual
Prefix:
First Name:PRISHNA
Middle Name:
Last Name:JIMENEZ-CASSAN
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3732 REDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-6512
Mailing Address - Country:US
Mailing Address - Phone:214-413-9181
Mailing Address - Fax:
Practice Address - Street 1:14673 MIDWAY RD
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-3171
Practice Address - Country:US
Practice Address - Phone:972-464-8668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87764101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor