Provider Demographics
NPI:1467471656
Name:MEHL, RICHARD FREDERICK (MDIV MFT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:FREDERICK
Last Name:MEHL
Suffix:
Gender:M
Credentials:MDIV MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23185 LA CADENA DR STE 104
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1480
Mailing Address - Country:US
Mailing Address - Phone:949-597-0202
Mailing Address - Fax:949-597-0202
Practice Address - Street 1:23185 LA CADENA DR STE 104
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1480
Practice Address - Country:US
Practice Address - Phone:949-597-0202
Practice Address - Fax:949-597-0202
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC25039106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC25039OtherMFT LICENSE