Healthcare Provider Details

I. General information

NPI: 1366388712
Provider Name (Legal Business Name): MENDOZA COUNSELING GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19000 NW 2ND AVE
MIAMI FL
33169-4011
US

IV. Provider business mailing address

19000 NW 2ND AVE
MIAMI FL
33169-4011
US

V. Phone/Fax

Practice location:
  • Phone: 786-757-6697
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JUAN G MENDOZA
Title or Position: DIRECTOR
Credential: LMHC
Phone: 786-757-6697