Provider Demographics
NPI:1598128464
Name:MINDLIN, DEBRA (MFT40852)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:MINDLIN
Suffix:
Gender:F
Credentials:MFT40852
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10450 WILSHIRE BLVD UNIT 12H
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4614
Mailing Address - Country:US
Mailing Address - Phone:310-717-7415
Mailing Address - Fax:
Practice Address - Street 1:10450 WILSHIRE BLVD UNIT 12H
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4614
Practice Address - Country:US
Practice Address - Phone:310-717-7415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40852106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist