Provider Demographics
NPI:1063186765
Name:MENDIVIL, SAYDE MARIA (MA)
Entity type:Individual
Prefix:
First Name:SAYDE
Middle Name:MARIA
Last Name:MENDIVIL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 UNIVERSITY AVENUE
Mailing Address - Street 2:BLDG B SUITE C
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3363
Mailing Address - Country:US
Mailing Address - Phone:575-544-5026
Mailing Address - Fax:
Practice Address - Street 1:665 UNIVERSITY AVENUE
Practice Address - Street 2:BLDG B SUITE C
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3363
Practice Address - Country:US
Practice Address - Phone:575-544-5026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health