MEDICARE: TASIA VICTORIA MENDIOLA 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

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	:	1871876748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TASIA VICTORIA MENDIOLA LPC

Provider Business Mailing Address
First Line	:	5300 N MERIDIAN AVE STE 11D
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-2179
Country	:	US
Telephone Number	:	405-600-8306
Fax Number	:

Provider Business Practice Location Address
First Line	:	5300 N MERIDIAN AVE STE 11D
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-2179
Country	:	US
Telephone Number	:	405-600-8306
Fax Number	:

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

Provider Enumeration Date	:	09/27/2011
Last Update Date	:	01/18/2024

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