Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 1400 | NM |
NPI | 1083071294 |
---|---|
Provider Name | Natalia Jimenez |
First Address | Waco, TX 76711-1329 |
Second Address | Waco, TX 76711-1329 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2016 |
Last Update Date | 19/01/2016 |