Provider Demographics
NPI:1124324090
Name:MENDOZA, MARJORIE Y (LPC)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:Y
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8321 S 100TH ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-2409
Mailing Address - Country:US
Mailing Address - Phone:414-719-0076
Mailing Address - Fax:
Practice Address - Street 1:1205 S 70TH ST STE 301
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-3171
Practice Address - Country:US
Practice Address - Phone:414-485-6302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-09
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7114-125101YP2500X
WI15574-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)