Provider Demographics
NPI:1942087887
Name:MENDOZA-FLORES, JUAN CARLOS (MS, TLLP)
Entity Type:Individual
Prefix:
First Name:JUAN CARLOS
Middle Name:
Last Name:MENDOZA-FLORES
Suffix:
Gender:M
Credentials:MS, TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 SPRUCE ST APT B1
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-3747
Mailing Address - Country:US
Mailing Address - Phone:906-251-8272
Mailing Address - Fax:
Practice Address - Street 1:102 W WASHINGTON ST STE 106
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4350
Practice Address - Country:US
Practice Address - Phone:906-228-8881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362009812103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling