Provider Demographics
NPI:1669951513
Name:MAINTHOW, ELLEN GERKEN (LMFT)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:GERKEN
Last Name:MAINTHOW
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1965 PORT TRINITY PL
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7127
Mailing Address - Country:US
Mailing Address - Phone:949-293-6246
Mailing Address - Fax:
Practice Address - Street 1:1965 PORT TRINITY PL
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7127
Practice Address - Country:US
Practice Address - Phone:949-293-6246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-11
Last Update Date:2018-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT27818101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health