Provider Demographics
NPI:1629103254
Name:GILLIHAN, MINDY MICHELLE (MFT)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:MICHELLE
Last Name:GILLIHAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 SILAS AVE
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-4442
Mailing Address - Country:US
Mailing Address - Phone:805-376-9856
Mailing Address - Fax:
Practice Address - Street 1:100 E THOUSAND OAKS BLVD
Practice Address - Street 2:SUITE #258
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-5713
Practice Address - Country:US
Practice Address - Phone:818-621-2578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36476106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist