Provider Demographics
NPI:1609118850
Name:JIMENEZ, AMADA L (PSYD)
Entity type:Individual
Prefix:MISS
First Name:AMADA
Middle Name:L
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MRS
Other - First Name:AMADA
Other - Middle Name:L
Other - Last Name:STRANGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1292 HIGH ST # 1176
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3238
Mailing Address - Country:US
Mailing Address - Phone:541-631-0848
Mailing Address - Fax:
Practice Address - Street 1:1292 HIGH ST # 1176
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3238
Practice Address - Country:US
Practice Address - Phone:541-631-0848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-25
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI103T00000X
OR3316103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist