Provider Demographics
NPI:1801595038
Name:JIMENEZ, CRISTINA (LMHC-A)
Entity type:Individual
Prefix:MISS
First Name:CRISTINA
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:LMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:953 BUCHANAN ST
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46803-4005
Mailing Address - Country:US
Mailing Address - Phone:260-310-5471
Mailing Address - Fax:
Practice Address - Street 1:2013 S ANTHONY BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46803-3609
Practice Address - Country:US
Practice Address - Phone:260-255-3514
Practice Address - Fax:260-570-4739
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88001832A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health