Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor |
NPI | 1003337411 |
---|---|
Provider Name | Janessa Lynette Jimenez |
First Address | Modesto, CA 95350-3839 |
Second Address | Modesto, CA 95350-3839 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2017 |
Last Update Date | 06/07/2017 |