Provider Demographics
NPI:1992989982
Name:MENCHACA, DEANNA FONSTEIN (MFT INTERN)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:FONSTEIN
Last Name:MENCHACA
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8945 W RUSSELL RD STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1225
Mailing Address - Country:US
Mailing Address - Phone:702-476-9294
Mailing Address - Fax:702-442-9538
Practice Address - Street 1:8945 W RUSSELL RD STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-1225
Practice Address - Country:US
Practice Address - Phone:702-476-9294
Practice Address - Fax:702-442-9538
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF93885106H00000X
NMCTB-2022-0240106H00000X
NVMI4275106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist