Provider Demographics
NPI:1174768261
Name:MENCHACA, WILLIAM (PSYD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:MENCHACA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5404 ODOM AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76114-4539
Mailing Address - Country:US
Mailing Address - Phone:682-429-8343
Mailing Address - Fax:
Practice Address - Street 1:100 E 15TH ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-6550
Practice Address - Country:US
Practice Address - Phone:817-332-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33495103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical