Provider Demographics
NPI:1508418971
Name:MIMS, PATRICIA JOHNSON (LMFT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JOHNSON
Last Name:MIMS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7737 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-1740
Mailing Address - Country:US
Mailing Address - Phone:619-439-2499
Mailing Address - Fax:619-439-2455
Practice Address - Street 1:7737 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-1740
Practice Address - Country:US
Practice Address - Phone:619-438-0880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA114090106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist