MEDICARE: MEGAN MENDOZA MSCP, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	3578-226	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295257251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN MENDOZA MSCP, LPC

Provider Business Mailing Address
First Line	:	120 CAMBRIDGE AVE APT 402
Second Line	:
City	:	WAUKESHA
State	:	WI
Zip	:	53188-4778
Country	:	US
Telephone Number	:	414-502-6231
Fax Number	:

Provider Business Practice Location Address
First Line	:	1121 W OKLAHOMA AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-4617
Country	:	US
Telephone Number	:	262-641-9790
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2017
Last Update Date	:	05/06/2021

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