Provider Demographics
NPI:1477696482
Name:MENDEZ, ODILIA P (LPCC)
Entity Type:Individual
Prefix:MS
First Name:ODILIA
Middle Name:P
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 MENAUL BLVD NE # 189
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2260
Mailing Address - Country:US
Mailing Address - Phone:505-269-4941
Mailing Address - Fax:
Practice Address - Street 1:2600 MARBLE AVE NE BLDG 2
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2058
Practice Address - Country:US
Practice Address - Phone:505-269-4941
Practice Address - Fax:956-289-7257
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12187101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health