Provider Demographics
NPI:1720961758
Name:SECRET GARDEN VIBES LLC
Entity type:Organization
Organization Name:SECRET GARDEN VIBES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:
Authorized Official - First Name:PRISHNA
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ-CASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:214-413-9181
Mailing Address - Street 1:3732 REDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-6512
Mailing Address - Country:US
Mailing Address - Phone:214-413-9181
Mailing Address - Fax:
Practice Address - Street 1:2900 W PARK ROW DR
Practice Address - Street 2:
Practice Address - City:PANTEGO
Practice Address - State:TX
Practice Address - Zip Code:76013-2049
Practice Address - Country:US
Practice Address - Phone:214-413-9181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-28
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty