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General NPI Number Information
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NPI Number | 1083578447
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Entity Type | Individual
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Provider Name | MALORY EMALEE MENDOZA LPC, LAC
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Gender | Female
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Dates
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Enumeration Date | 12/10/2025
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 301 BOULDER ST UNIT 1406
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City | MINTURN
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State | CO
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Zip | 81645-5067
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Country | US
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Telephone | 774-208-3937
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Fax |
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Provider Business Mailing Address
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Address Line | 301 BOULDER ST UNIT 1406
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City | MINTURN
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State | CO
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Zip | 81645-5067
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Country | US
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Telephone | 774-208-3937
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | ACD.0002705
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPC.0023014
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License Number State | CO
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