Provider Demographics
NPI:1659085579
Name:MILLS, BRANDY (AMFT)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:MILLS
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 MANZANITA LN
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-4245
Mailing Address - Country:US
Mailing Address - Phone:310-947-2739
Mailing Address - Fax:
Practice Address - Street 1:2309 PCH HWY STE 207
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2753
Practice Address - Country:US
Practice Address - Phone:310-947-2739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA136875101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health