Healthcare Provider Details

I. General information

NPI: 1538679790
Provider Name (Legal Business Name): EVELYN COYOY MENCHU LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2017
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19877 EMMETT RD
CANYON COUNTRY CA
91351-4801
US

IV. Provider business mailing address

19877 EMMETT RD
CANYON COUNTRY CA
91351-4801
US

V. Phone/Fax

Practice location:
  • Phone: 818-600-2038
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number129131
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: