Provider Demographics
NPI:1811509680
Name:MENDOZA, YESSICA (LPC)
Entity type:Individual
Prefix:
First Name:YESSICA
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7025 W EMERALD ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8657
Mailing Address - Country:US
Mailing Address - Phone:208-947-0863
Mailing Address - Fax:208-672-0324
Practice Address - Street 1:7025 W EMERALD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8657
Practice Address - Country:US
Practice Address - Phone:208-947-0863
Practice Address - Fax:208-672-0324
Is Sole Proprietor?:No
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-7788101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health