Provider Demographics
NPI:1235665910
Name:MENCHEY, GARY JON (MSW, LCDC, QMHP-CS)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:JON
Last Name:MENCHEY
Suffix:
Gender:M
Credentials:MSW, LCDC, QMHP-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4521 CUPID DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79924-1723
Mailing Address - Country:US
Mailing Address - Phone:915-747-3605
Mailing Address - Fax:
Practice Address - Street 1:4521 CUPID DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-1723
Practice Address - Country:US
Practice Address - Phone:915-747-3605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11702101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)