Giannina Fuentes Mendieta, LCSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

8483250-3503 Issued in UT

Practice address

415 Medical Dr Ste D101
Bountiful, UT 84010-8905

Phone

(801) 683-1062

NPI assigned

Aug 22, 2016

Last updated

Nov 27, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1471824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1699220442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 MEDICAL DR STE D101",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840108905",
            "telephone_number": "801-683-1062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 MEDICAL DR STE D101",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840108905",
            "telephone_number": "801-683-1062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUENTES MENDIETA",
        "first_name": "GIANNINA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-08-22",
        "last_updated": "2023-11-27",
        "certification_date": "2020-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "UT",
            "license": "8483250-3503",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "giannina.fuentes@neurobcg.com",
            "affiliation": "Y",
            "affiliationName": "Neurobehavioral Center for Growth LLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "415 Medical Dr Ste D101",
            "city": "Bountiful",
            "state": "UT",
            "country_code": "US",
            "postal_code": "840108905",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Suzette Leann Fritinger, LCSW
• Frogley Health and Wellness
• Frogley Holding LLC
• Cory M Frogley, D.C.
• Nickolas Fronk
• Christopher Fuentes
• Anna Fuertes
• Aubry Grace Fullman
• G Sam Wilson MD PC
• Christina Marie Gaan

• Mental Health Counselor in Bountiful, UT
• Providers in Bountiful, UT by specialty
• Mental Health Counselor in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.