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NPI Code Detail

MEDICARE: DEANNA FONSTEIN MENCHACA MFT INTERN

MEDICARE: DEANNA FONSTEIN MENCHACA MFT INTERN
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
1106H00000XMarriage & Family TherapistIMF93885CA
2106H00000XMarriage & Family TherapistCTB-2022-0240NM
3106H00000XMarriage & Family TherapistMI4275NV

General Provider Information

NPI Number : 1992989982
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEANNA FONSTEIN MENCHACA MFT INTERN
Provider Business Mailing Address
First Line : 8945 W RUSSELL RD STE 110
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-1225
Country : US
Telephone Number : 702-476-9294
Fax Number : 702-442-9538
Provider Business Practice Location Address
First Line : 8945 W RUSSELL RD STE 110
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-1225
Country : US
Telephone Number : 702-476-9294
Fax Number : 702-442-9538
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/26/2007
Last Update Date : 08/24/2023

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Directions to “ DEANNA FONSTEIN MENCHACA MFT INTERN” Practice Location

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