Provider Demographics
NPI:1437304003
Name:MENCHACA, RAYMOND J (MFTI 58715)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:J
Last Name:MENCHACA
Suffix:
Gender:M
Credentials:MFTI 58715
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 MCGINNESS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95127-4025
Mailing Address - Country:US
Mailing Address - Phone:408-928-5777
Mailing Address - Fax:408-929-9011
Practice Address - Street 1:1212 MCGINNESS AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-4025
Practice Address - Country:US
Practice Address - Phone:408-928-5777
Practice Address - Fax:408-929-9011
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFTI 58715101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health