Provider Demographics
NPI:1891810958
Name:JIMENEZ, MANUEL JIMENEZ JR (LMFT)
Entity Type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:JIMENEZ
Last Name:JIMENEZ
Suffix:JR
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2881 JUBILEE DR
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-8430
Mailing Address - Country:US
Mailing Address - Phone:209-633-3057
Mailing Address - Fax:
Practice Address - Street 1:2111 GEER RD STE 510
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2472
Practice Address - Country:US
Practice Address - Phone:209-633-3057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 37868101YM0800X
CALMFT37868106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health