Individual
GRACE MENDOZA
Active
Individual
GRACE MENDOZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSC, LPC
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
LAC-14449
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18085
LICENSURE NUMBER
AZ
Enumeration date
09/14/2016
Last updated
05/11/2021
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