Provider Demographics
NPI:1174659676
Name:MINTZLAFF, VIRGINIA A (MS,LMFT)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:A
Last Name:MINTZLAFF
Suffix:
Gender:F
Credentials:MS,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 E KATELLA AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-4836
Mailing Address - Country:US
Mailing Address - Phone:714-292-2292
Mailing Address - Fax:714-771-9710
Practice Address - Street 1:128 E KATELLA AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-4836
Practice Address - Country:US
Practice Address - Phone:714-292-2292
Practice Address - Fax:714-771-9710
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41854106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist