Provider Demographics
NPI:1083748552
Name:MANTELL, JAMIE E
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:E
Last Name:MANTELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10073 VALLEY VIEW ST # 134
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-4601
Mailing Address - Country:US
Mailing Address - Phone:714-722-4880
Mailing Address - Fax:
Practice Address - Street 1:10073 VALLEY VIEW ST # 134
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-4601
Practice Address - Country:US
Practice Address - Phone:714-722-4880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC47526106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist