Healthcare Provider Details

I. General information

NPI: 1073446852
Provider Name (Legal Business Name): ABIGAIL MENDOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 SAINT JOHN ST
GARDEN CITY KS
67846-5128
US

IV. Provider business mailing address

301 S WILSON ST
ULYSSES KS
67880-2354
US

V. Phone/Fax

Practice location:
  • Phone: 620-275-1766
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number03548-T
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: