Provider Demographics
NPI:1225704273
Name:MENA, EMMANUEL (BHT)
Entity Type:Individual
Prefix:MR
First Name:EMMANUEL
Middle Name:
Last Name:MENA
Suffix:
Gender:M
Credentials:BHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3842 E IRWIN AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-3852
Mailing Address - Country:US
Mailing Address - Phone:602-394-2689
Mailing Address - Fax:
Practice Address - Street 1:3842 E IRWIN AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3852
Practice Address - Country:US
Practice Address - Phone:602-394-2689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician