MEDICARE: BRENDA LYNNE MENCHACA STEPHENS LPCC

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	4366	CA

General Provider Information

NPI Number	:	1740419316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA LYNNE MENCHACA STEPHENS LPCC

Provider Business Mailing Address
First Line	:	8775 AERO DR STE 240
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1756
Country	:	US
Telephone Number	:	619-304-4852
Fax Number	:	888-337-3402

Provider Business Practice Location Address
First Line	:	8775 AERO DR STE 240
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1756
Country	:	US
Telephone Number	:	619-304-4852
Fax Number	:	888-337-3402

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

Provider Enumeration Date	:	07/04/2009
Last Update Date	:	11/28/2022

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