Provider Demographics
NPI:1588679237
Name:MENCHACA, ANNABEL (LPC)
Entity Type:Individual
Prefix:MISS
First Name:ANNABEL
Middle Name:
Last Name:MENCHACA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 CAMDEN ST STE 510
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-2015
Mailing Address - Country:US
Mailing Address - Phone:210-591-1615
Mailing Address - Fax:210-591-1635
Practice Address - Street 1:311 CAMDEN ST STE 510
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-2015
Practice Address - Country:US
Practice Address - Phone:210-591-1615
Practice Address - Fax:210-591-1635
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17719101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172019501Medicaid