Healthcare Provider Details

I. General information

NPI: 1134646482
Provider Name (Legal Business Name): MARIO MENDES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MARIO MENDES LMHC

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 S CONGRESS AVE
WEST PALM BEACH FL
33406-7608
US

IV. Provider business mailing address

7000 N FEDERAL HWY FL 1
BOCA RATON FL
33487-1644
US

V. Phone/Fax

Practice location:
  • Phone: 561-432-5849
  • Fax: 561-432-9732
Mailing address:
  • Phone: 561-353-9382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH12720
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: