Provider Demographics
NPI:1760547053
Name:MENDEZ, SUSANA ELENA (LAC, LCDC)
Entity Type:Individual
Prefix:DR
First Name:SUSANA
Middle Name:ELENA
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:LAC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 PATRICK CT
Mailing Address - Street 2:
Mailing Address - City:VAN ALSTYNE
Mailing Address - State:TX
Mailing Address - Zip Code:75495-3456
Mailing Address - Country:US
Mailing Address - Phone:214-566-0149
Mailing Address - Fax:
Practice Address - Street 1:14114 DALLAS PKWY STE 245
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-1331
Practice Address - Country:US
Practice Address - Phone:214-566-0149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5991101YA0400X
TXAC00939171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)