Basic Information
| Provider Information | |||||||||
| NPI: | 1760547053 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MENDEZ | ||||||||
| FirstName: | SUSANA | ||||||||
| MiddleName: | ELENA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | L.AC, LCDC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5310 KELLER SPRINGS RD | ||||||||
| Address2: | SUITE 713 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752482777 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2145660149 | ||||||||
| FaxNumber: | 2149413422 | ||||||||
| Practice Location | |||||||||
| Address1: | 233 WEST 10TH STREET | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2149413500 | ||||||||
| FaxNumber: | 2149413422 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 5991 | TX | X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 171100000X | AC00939 | TX | X | Other Service Providers | Acupuncturist |
No ID Information.