MEDICARE: MENDEZ COUNSELING AND WELLNESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1619519097
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENDEZ COUNSELING AND WELLNESS LLC

Provider Business Mailing Address
First Line	:	17588 SW 28TH CT
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33029-5564
Country	:	US
Telephone Number	:	754-216-8714
Fax Number	:	888-886-7975

Provider Business Practice Location Address
First Line	:	1515 N UNIVERSITY DR STE 114A
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-6084
Country	:	US
Telephone Number	:	754-216-8714
Fax Number	:	888-886-7975

Authorized Official
Title or Position	:	PROVIDER, OWNER
Name	:	LIANET MENDEZ
Credential	:	LMHC
Telephone Number	:	754-216-8714

Provider Enumeration Date	:	10/17/2019
Last Update Date	:	10/17/2019

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