Healthcare Provider Details

I. General information

NPI: 1982180642
Provider Name (Legal Business Name): KYNDRA MENDEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 COYLE AVE
CARMICHAEL CA
95608-0306
US

IV. Provider business mailing address

PO BOX 342
ORANGEVALE CA
95662-0342
US

V. Phone/Fax

Practice location:
  • Phone: 916-537-5333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number100935
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: