Provider Demographics
NPI:1871876748
Name:MENDIOLA, TASIA VICTORIA (LPC)
Entity type:Individual
Prefix:
First Name:TASIA
Middle Name:VICTORIA
Last Name:MENDIOLA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 N MERIDIAN AVE STE 11D
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-2179
Mailing Address - Country:US
Mailing Address - Phone:405-600-8306
Mailing Address - Fax:
Practice Address - Street 1:5300 N MERIDIAN AVE STE 11D
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2179
Practice Address - Country:US
Practice Address - Phone:405-600-8306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200049040Medicaid