Healthcare Provider Details

I. General information

NPI: 1114545670
Provider Name (Legal Business Name): VERONIKA MARIA MENDOZA LPCC, LEP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2020
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W TOWN AND COUNTRY RD STE 1250
ORANGE CA
92868-4633
US

IV. Provider business mailing address

1100 W TOWN AND COUNTRY RD STE 1250
ORANGE CA
92868-4633
US

V. Phone/Fax

Practice location:
  • Phone: 657-331-4579
  • Fax: 657-331-4557
Mailing address:
  • Phone: 657-331-4579
  • Fax: 657-331-4557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number3954
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7676
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: