Individual
JUAN MIGUEL JIMENEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
713 NW 139TH ST, EDMOND, OK 73013-1912
(702) 249-1309
Mailing address
713 NW 139TH ST, EDMOND, OK 73013-1912
(702) 249-1309
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
09/22/2020
Last updated
09/23/2020
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