Provider Demographics
NPI:1932492782
Name:MENDOZA, AMY (LAC)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:MUNOZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:1650 E FORT LOWELL RD
Mailing Address - Street 2:#202
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-2374
Mailing Address - Country:US
Mailing Address - Phone:520-202-1759
Mailing Address - Fax:520-202-1889
Practice Address - Street 1:1650 E FORT LOWELL RD
Practice Address - Street 2:#202
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-2374
Practice Address - Country:US
Practice Address - Phone:520-202-1759
Practice Address - Fax:520-202-1889
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-13463101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health