Provider Demographics
NPI:1720603046
Name:JIMENEZ, PHOENIX J (CSW)
Entity type:Individual
Prefix:
First Name:PHOENIX
Middle Name:J
Last Name:JIMENEZ
Suffix:
Gender:
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 N SCOTTSDALE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-3429
Mailing Address - Country:US
Mailing Address - Phone:844-808-7792
Mailing Address - Fax:
Practice Address - Street 1:2940 N CHURCH ST STE 303
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84040-6617
Practice Address - Country:US
Practice Address - Phone:801-935-4171
Practice Address - Fax:385-227-8653
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2025-03-18
Deactivation Date:2025-02-28
Deactivation Code:
Reactivation Date:2025-03-18
Provider Licenses
StateLicense IDTaxonomies
UT14200073-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical