Provider Demographics
NPI:1164175360
Name:MENDOZA, KIMBERLEE SUE (LMFT)
Entity Type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:SUE
Last Name:MENDOZA
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 1:440 E PAYSON ST
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-5623
Mailing Address - Country:US
Mailing Address - Phone:714-269-4070
Mailing Address - Fax:
Practice Address - Street 1:216 N GLENDORA AVE STE 203C
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-6924
Practice Address - Country:US
Practice Address - Phone:909-454-3991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA127122106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist