=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053068098
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IRMA MENDEZ LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2022
-----------------------------------------------------
Last Update Date | 04/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9473 SOCORRO RD
-----------------------------------------------------
City | EL PASO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79907-5619
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-858-1076
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9473 SOCORRO RD
-----------------------------------------------------
City | EL PASO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79907-5619
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-858-1076
-----------------------------------------------------
Fax | 915-242-6562
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 83928
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------