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General NPI Number Information
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NPI Number | 1124997549
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Entity Type | Organization
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Legal Business Name | MENTEVO LLC
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Dates
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Enumeration Date | 11/03/2025
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 18313 CANDICE DR
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City | TRIANGLE
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State | VA
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Zip | 22172-1413
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Country | US
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Telephone | 720-289-9116
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Fax |
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Provider Business Mailing Address
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Address Line | 18313 CANDICE DR
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City | TRIANGLE
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State | VA
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Zip | 22172-1413
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Country | US
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Telephone | 720-289-9116
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALYSE NANETTA MUNOZ
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Credential | EDD, LCSW
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Telephone | 720-289-9116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TE1100X
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Taxonomy Name | Exercise & Sports Psychologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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