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General NPI Number Information
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NPI Number | 1619627551
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Entity Type | Individual
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Provider Name | LISA D MENDOZA LPCC
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Gender | Female
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Dates
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Enumeration Date | 03/24/2022
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 2626 E 82ND ST STE 335
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City | BLOOMINGTON
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State | MN
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Zip | 55425-1682
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Country | US
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Telephone | 651-263-4149
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Fax |
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Provider Business Mailing Address
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Address Line | 3335 BUCHANAN ST NE
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City | MINNEAPOLIS
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State | MN
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Zip | 55418-1449
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Country | US
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Telephone | 651-263-4149
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CC04077
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State | MN
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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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