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General NPI Number Information
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NPI Number | 1730261934
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Entity Type | Individual
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Provider Name | NICKY MENDENHALL LISW, LMFT
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Gender | Female
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 939 OFFICE PARK RD SUITE 112
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City | WEST DES MOINES
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State | IA
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Zip | 50265-2505
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Country | US
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Telephone | 515-274-6335
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Fax | 515-274-9269
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Provider Business Mailing Address
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Address Line | 939 OFFICE PARK RD SUITE 112
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City | WEST DES MOINES
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State | IA
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Zip | 50265-2505
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Country | US
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Telephone | 515-274-6335
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Fax | 515-274-9269
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 00010
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 00029
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License Number State | IA
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