Provider Demographics
NPI:1891400438
Name:JIMENEZ, CLARA L (LPC)
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:L
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 N 55TH AVE STE 102-176
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-1321
Mailing Address - Country:US
Mailing Address - Phone:602-677-6931
Mailing Address - Fax:
Practice Address - Street 1:3502 W CINNABAR AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-1256
Practice Address - Country:US
Practice Address - Phone:602-677-6931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-20977101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health