Healthcare Provider Details

I. General information

NPI: 1629148101
Provider Name (Legal Business Name): MINDI WOLF B.A. PSYCHOLOGY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 W CERRITOS AVE BLDG #8
ANAHEIM CA
92805-6549
US

IV. Provider business mailing address

249 TAROCCO
IRVINE CA
92618-0315
US

V. Phone/Fax

Practice location:
  • Phone: 714-254-8473
  • Fax: 714-254-8480
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: