Healthcare Provider Details

I. General information

NPI: 1558694695
Provider Name (Legal Business Name): GRACE MENDEZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 12/27/2021
Certification Date: 12/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 E YANDELL DR
EL PASO TX
79902-5714
US

IV. Provider business mailing address

1725 E YANDELL DR
EL PASO TX
79902-5714
US

V. Phone/Fax

Practice location:
  • Phone: 915-783-7430
  • Fax: 915-534-7887
Mailing address:
  • Phone: 915-783-7430
  • Fax: 915-534-7887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number13123
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: