Healthcare Provider Details

I. General information

NPI: 1851312334
Provider Name (Legal Business Name): JAMES L MENA MA, LPC, LCDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 11/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7109 FM 2920 RD STE 600
SPRING TX
77379-2218
US

IV. Provider business mailing address

7109 FM 2920 RD STE 600
SPRING TX
77379-2218
US

V. Phone/Fax

Practice location:
  • Phone: 281-205-8786
  • Fax: 832-559-1939
Mailing address:
  • Phone: 281-205-8786
  • Fax: 832-559-1939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number17328
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: