Provider Demographics
NPI:1992689996
Name:INTEGRATED MENTAL HEALTH CLINIC
Entity type:Organization
Organization Name:INTEGRATED MENTAL HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-352-1553
Mailing Address - Street 1:4014 DIAMONDHEAD AVE
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-1308
Mailing Address - Country:US
Mailing Address - Phone:202-352-1553
Mailing Address - Fax:
Practice Address - Street 1:950 N WASHINGTON ST FL 3
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2398
Practice Address - Country:US
Practice Address - Phone:703-570-5657
Practice Address - Fax:703-570-5661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty