Provider Demographics
NPI:1114366911
Name:MENDEZ, TAHNEE ISIS (LMFT)
Entity Type:Individual
Prefix:
First Name:TAHNEE
Middle Name:ISIS
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22584 SW 64TH WAY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-6003
Mailing Address - Country:US
Mailing Address - Phone:954-793-8667
Mailing Address - Fax:
Practice Address - Street 1:22584 SW 64TH WAY
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-6003
Practice Address - Country:US
Practice Address - Phone:954-793-8667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 2771106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist