Provider Demographics
NPI:1912375114
Name:MINTZ, STEPHANIE (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MINTZ
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6020 SEABLUFF DR UNIT 125
Mailing Address - Street 2:
Mailing Address - City:PLAYA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:90094-2254
Mailing Address - Country:US
Mailing Address - Phone:424-248-8766
Mailing Address - Fax:
Practice Address - Street 1:6020 SEABLUFF DR UNIT 125
Practice Address - Street 2:
Practice Address - City:PLAYA VISTA
Practice Address - State:CA
Practice Address - Zip Code:90094-2254
Practice Address - Country:US
Practice Address - Phone:424-248-8766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-04
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84968106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist