Provider Demographics
NPI:1982307732
Name:MENDOZA, EMILY EILEEN (LPC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:EILEEN
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:EILEEN
Other - Last Name:FELLERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7611 STATE LINE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-1670
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7611 STATE LINE RD STE 200
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-1670
Practice Address - Country:US
Practice Address - Phone:816-653-3927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019000932101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor