Healthcare Provider Details

I. General information

NPI: 1699666917
Provider Name (Legal Business Name): CARLA MENDIOLA MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 E HUNTLAND DR STE 320
AUSTIN TX
78752-3741
US

IV. Provider business mailing address

1838 RIVER CROSSING CIR APT C
AUSTIN TX
78741-3287
US

V. Phone/Fax

Practice location:
  • Phone: 512-201-4501
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number206095
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: