MEDICARE: CYNTHIA AZUCENA MENDOZA LIZARRAGA

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	101YM0800X	Mental Health Counselor	180.015582	IL

General Provider Information

NPI Number	:	1750248753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA AZUCENA MENDOZA LIZARRAGA

Provider Business Mailing Address
First Line	:	4715 W ADAMS ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60644-4635
Country	:	US
Telephone Number	:	847-312-1409
Fax Number	:

Provider Business Practice Location Address
First Line	:	4715 W ADAMS ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60644-4635
Country	:	US
Telephone Number	:	847-312-1409
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2026
Last Update Date	:	01/09/2026

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