Healthcare Provider Details

I. General information

NPI: 1427971316
Provider Name (Legal Business Name): AMANDA MENDOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 KIETZKE LN BLDG L
RENO NV
89502-5033
US

IV. Provider business mailing address

75 GALLERON WAY
SPARKS NV
89431-2315
US

V. Phone/Fax

Practice location:
  • Phone: 775-636-7767
  • Fax:
Mailing address:
  • Phone: 775-502-8040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCI5849
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: