Provider Demographics
NPI:1689369605
Name:MENDOZA, ANGELICA LYNN (MA, LPC)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:LYNN
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:ANGELICA
Other - Middle Name:LYNN
Other - Last Name:GARICA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:4 PRINCE VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-2140
Mailing Address - Country:US
Mailing Address - Phone:719-252-0243
Mailing Address - Fax:
Practice Address - Street 1:4 PRINCE VALLEY CT
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-2140
Practice Address - Country:US
Practice Address - Phone:719-252-0243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0018541101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health