Provider Demographics
NPI:1851443253
Name:MENDEZ, DEBBIE JEAN (LMFT)
Entity Type:Individual
Prefix:MS
First Name:DEBBIE
Middle Name:JEAN
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MISS
Other - First Name:DEBBIE
Other - Middle Name:JEAN
Other - Last Name:TENEYCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5404 LAUREL HILLS DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95841
Mailing Address - Country:US
Mailing Address - Phone:916-609-4013
Mailing Address - Fax:916-331-6252
Practice Address - Street 1:5404 LAUREL HILLS DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841
Practice Address - Country:US
Practice Address - Phone:916-609-4013
Practice Address - Fax:916-331-6252
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42776106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3908Medicaid