Individual
MR. LUIS A MENDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BA
Contact information
Practice address
311 S MADISON AVE, TULSA, OK 74120-3208
(918) 582-0061
Mailing address
311 S MADISON AVE, TULSA, OK 74120-3208
(918) 582-0061
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
K86000093
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100710510E
—
OK
Enumeration date
09/23/2011
Last updated
09/23/2011
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