Basic Information
| Provider Information | |||||||||
| NPI: | 1588679237 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MENCHACA | ||||||||
| FirstName: | ANNABEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 311 CAMDEN ST STE 510 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782152015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105911615 | ||||||||
| FaxNumber: | 2105911635 | ||||||||
| Practice Location | |||||||||
| Address1: | 311 CAMDEN ST STE 510 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782152015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105911615 | ||||||||
| FaxNumber: | 2105911635 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2006 | ||||||||
| LastUpdateDate: | 07/06/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 17719 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Professional | 101YM0800X | 17719 | TX | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 172019501 | 05 | TX | MEDICAID |