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General NPI Number Information
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NPI Number | 1588482129
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Entity Type | Individual
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Provider Name | ALYSSA BRIANNE MENDEZ MSW, RBT
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Gender | Female
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Dates
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Enumeration Date | 10/02/2024
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 604 S WALNUT ST
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City | STILLWATER
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State | OK
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Zip | 74074-4222
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Country | US
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Telephone | 844-458-2100
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Fax |
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Provider Business Mailing Address
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Address Line | 4020 WHITETAIL CIR
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City | GUTHRIE
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State | OK
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Zip | 73044-6154
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Country | US
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Telephone | 419-377-2682
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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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 | 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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