Provider Demographics
NPI:1992882104
Name:MEHL, JEANNIE (MA, LPC)
Entity type:Individual
Prefix:
First Name:JEANNIE
Middle Name:
Last Name:MEHL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3862
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86302
Mailing Address - Country:US
Mailing Address - Phone:928-778-7958
Mailing Address - Fax:
Practice Address - Street 1:501 KAREN DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-5425
Practice Address - Country:US
Practice Address - Phone:928-778-7958
Practice Address - Fax:928-778-3464
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2025-08-27
Deactivation Date:2025-03-12
Deactivation Code:
Reactivation Date:2025-08-27
Provider Licenses
StateLicense IDTaxonomies
AZLPC10124101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ754516Medicaid