Provider Demographics
NPI:1528663028
Name:JIMENEZ, MATTHEW M (ACMHC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:M
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:ACMHC
Other - Prefix:
Other - First Name:MATTHEW
Other - Middle Name:M
Other - Last Name:JIMENEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:403 E ALEXANDRA CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84115-2546
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1268 N VALLEY HEIGHTS CIR HEBER CITY, UT 84032 UNITED
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032
Practice Address - Country:US
Practice Address - Phone:844-313-6749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health