Provider Demographics
NPI:1831317841
Name:MOHAN, ANGELA (MFC 31627)
Entity Type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:
Last Name:MOHAN
Suffix:
Gender:F
Credentials:MFC 31627
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 MAPLE CT #225
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003
Mailing Address - Country:US
Mailing Address - Phone:805-794-8121
Mailing Address - Fax:805-659-1740
Practice Address - Street 1:200 S. WELLS RD
Practice Address - Street 2:SUITE 225
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93004
Practice Address - Country:US
Practice Address - Phone:805-647-6322
Practice Address - Fax:805-647-7164
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MFC 31627106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC31627OtherBOARD OF BEHAVIORAL SCIEN