Provider Demographics
NPI:1437675501
Name:MENDIZABAL, STEPHANI JO (LMHC, NCC, CCMHC)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANI
Middle Name:JO
Last Name:MENDIZABAL
Suffix:
Gender:F
Credentials:LMHC, NCC, CCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 PARK DR STE 2A
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763-1023
Mailing Address - Country:US
Mailing Address - Phone:813-410-4671
Mailing Address - Fax:
Practice Address - Street 1:2725 PARK DR STE 2A
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-1023
Practice Address - Country:US
Practice Address - Phone:813-410-4671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14801101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health