Healthcare Provider Details

I. General information

NPI: 1124997549
Provider Name (Legal Business Name): MENTEVO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18313 CANDICE DR
TRIANGLE VA
22172-1413
US

IV. Provider business mailing address

18313 CANDICE DR
TRIANGLE VA
22172-1413
US

V. Phone/Fax

Practice location:
  • Phone: 720-289-9116
  • Fax:
Mailing address:
  • Phone: 720-289-9116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. ALYSE NANETTA MUNOZ
Title or Position: OWNER
Credential: EDD, LCSW
Phone: 720-289-9116