Provider Demographics
NPI:1710956800
Name:MUNDT, PAUL RONALD (LMFT)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:RONALD
Last Name:MUNDT
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17291 IRVINE BLVD.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780
Mailing Address - Country:US
Mailing Address - Phone:714-270-0200
Mailing Address - Fax:807-566-3041
Practice Address - Street 1:17291 IRVINE BLVD.
Practice Address - Street 2:SUITE 103
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780
Practice Address - Country:US
Practice Address - Phone:714-270-0200
Practice Address - Fax:807-566-3041
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49936106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist