Healthcare Provider Details

I. General information

NPI: 1326654377
Provider Name (Legal Business Name): MICHAEL MENENDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2915 GRANT ST
OMAHA NE
68111-3863
US

IV. Provider business mailing address

11331 MARTIN AVE # NE68164
OMAHA NE
68164-6811
US

V. Phone/Fax

Practice location:
  • Phone: 402-451-3553
  • Fax:
Mailing address:
  • Phone: 402-510-9975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4109
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: