Individual
JACQUELINE K MENDOZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, ACSW,LCDC (TX)
Contact information
Practice address
4615 GOVERNMENT ST BLDG 1, BATON ROUGE, LA 70806-5922
(225) 922-0478
(225) 922-2658
Mailing address
1030 S EUGENE ST, BATON ROUGE, LA 70806-5478
(225) 931-9981
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0189
TX
101YA0400X
Addiction (Substance Use Disorder) Counselor
9979
TX
1041C0700X
Clinical Social Worker
Primary
32084
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0079KX
BLUE CROSS BLUE SHIELD
TX
01
—
2195773
FIRST HEALTH NETWORK
TX
01
—
2230312
CIGNA
TX
01
—
258450000
MAGELLAN HEALTH SERVICES
TX
01
—
309302
MHN
TX
Enumeration date
12/30/2006
Last updated
01/04/2012
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