Healthcare Provider Details

I. General information

NPI: 1316118680
Provider Name (Legal Business Name): RALPH G MENDEZ LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RALPH G MENDEZ PHD

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 MARBLE AVE NE
ALBUQUERQUE NM
87106-2058
US

IV. Provider business mailing address

2600 MARBLE AVE NE
ALBUQUERQUE NM
87106-2058
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-9743
  • Fax:
Mailing address:
  • Phone: 505-272-9743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0103591
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: