Provider Demographics
NPI:1295257251
Name:MENDOZA, MEGAN (MSCP, LPC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:MSCP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CAMBRIDGE AVE APT 402
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-4778
Mailing Address - Country:US
Mailing Address - Phone:414-502-6231
Mailing Address - Fax:
Practice Address - Street 1:1121 W OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4617
Practice Address - Country:US
Practice Address - Phone:262-641-9790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-12
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3578-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100069206Medicaid