Provider Demographics
NPI:1265026835
Name:MENDILLO, JEFFREY P (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:P
Last Name:MENDILLO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206A S LOOP 336 W
Mailing Address - Street 2:UNIT 312
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304
Mailing Address - Country:US
Mailing Address - Phone:936-701-0894
Mailing Address - Fax:
Practice Address - Street 1:100 I-45 NORTH
Practice Address - Street 2:SUITE 320
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301
Practice Address - Country:US
Practice Address - Phone:936-701-0894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2022-02-07
Deactivation Date:2021-04-08
Deactivation Code:
Reactivation Date:2022-02-07
Provider Licenses
StateLicense IDTaxonomies
TX659111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical