Healthcare Provider Details

I. General information

NPI: 1013556786
Provider Name (Legal Business Name): JODEE MENDEZ M.A.E.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2019
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 MAIN ST
TORRINGTON WY
82240-3340
US

IV. Provider business mailing address

PO BOX 1117
TORRINGTON WY
82240-1117
US

V. Phone/Fax

Practice location:
  • Phone: 307-532-4197
  • Fax:
Mailing address:
  • Phone: 307-532-4197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: