Basic Information
| Provider Information | |||||||||
| NPI: | 1235587536 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JIMENEZ | ||||||||
| FirstName: | JESSICA | ||||||||
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| Credential: | PLPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10918 ELM AVE | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641344108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8167656600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10918 ELM AVE | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641344108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8167656600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2016 | ||||||||
| LastUpdateDate: | 05/26/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 2016008348 | MO | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.