Provider Demographics
NPI:1346086659
Name:MENDOZA, AMANDA MAY (LPC STUDENT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MAY
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:LPC STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2904 WILL ROGERS PL
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99517-2463
Mailing Address - Country:US
Mailing Address - Phone:303-960-7514
Mailing Address - Fax:
Practice Address - Street 1:2121 ABBOTT RD STE 201
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-4450
Practice Address - Country:US
Practice Address - Phone:907-522-7080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health