1538442074 NPI number — CATHLEEN A MENDA LMHC

Table of content: CATHLEEN A MENDA LMHC (NPI 1538442074)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538442074 NPI number — CATHLEEN A MENDA LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MENDA
Provider First Name:
CATHLEEN
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538442074
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6706 N 9TH AVE STE A1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENSACOLA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32504-7398
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-380-0440
Provider Business Mailing Address Fax Number:
850-471-1790

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6706 N 9TH AVE
Provider Second Line Business Practice Location Address:
SUITE A1
Provider Business Practice Location Address City Name:
PENSACOLA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32504-9303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-380-0440
Provider Business Practice Location Address Fax Number:
850-471-1790
Provider Enumeration Date:
09/21/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MH 11975 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)