=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003452400
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTEGRATED MARRIAGE COUNSELING & CONSULTING PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2019
-----------------------------------------------------
Last Update Date | 02/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21201 VICTORY BLVD STE 200
-----------------------------------------------------
City | WOODLAND HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91303-2866
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-804-1284
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20201 ITASCA ST
-----------------------------------------------------
City | CHATSWORTH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91311-5415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-804-1284
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, CLINICAL DIRECTOR
-----------------------------------------------------
Name | JACQUELINE N MENDEZ
-----------------------------------------------------
Credential | LMFT, CST
-----------------------------------------------------
Telephone | 818-804-1284
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------