Active NPI
Grace Mendoza, MSC, LPC
- Community/Behavioral Health Agency
- San Tan Valley, AZ
National Provider Identifier
1801344296
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Behavioral Health Agency
- License
- LAC-14449
- Practice address
- 1180 W Desert Seasons Dr
San Tan Valley, AZ 85143-3438 - Phone
- (480) 390-9811
- NPI assigned
- Sep 14, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | LAC-14449 | AZ | Primary |
Addresses
Primary practice location
1180 W Desert Seasons Dr
San Tan Valley, AZ 85143-3438
Mailing address
1180 W Desert Seasons Dr
San Tan Valley, AZ 85143-3438
Phone (480) 390-9811
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 18085 | Other | AZ | LICENSURE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LAC-14449 | AZ | MD | Community/Behavioral Health Agency |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1473811200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620691200000",
"number": "1801344296",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1180 W DESERT SEASONS DR",
"city": "SAN TAN VALLEY",
"state": "AZ",
"postal_code": "851433438",
"telephone_number": "480-390-9811"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1180 W DESERT SEASONS DR",
"city": "SAN TAN VALLEY",
"state": "AZ",
"postal_code": "851433438",
"telephone_number": "480-390-9811"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MENDOZA",
"first_name": "GRACE",
"credential": "MSC, LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-09-14",
"last_updated": "2021-05-11",
"certification_date": "2021-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": "AZ",
"license": "LAC-14449",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSURE NUMBER",
"identifier": "18085",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Tan Valley, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.