Provider Demographics
NPI:1235267642
Name:MITHA, PATRICIA (LMFT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:MITHA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:ESTRADA-MITHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:898 VIA MINDI
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3632
Mailing Address - Country:US
Mailing Address - Phone:310-508-6845
Mailing Address - Fax:
Practice Address - Street 1:1200 WILSHIRE BLVD STE 500
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-1934
Practice Address - Country:US
Practice Address - Phone:213-481-7464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF44312106H00000X
CAMFC 49985106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist