Healthcare Provider Details

I. General information

NPI: 1679088934
Provider Name (Legal Business Name): LAURA MONTELL MINOR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURA MINO

II. Dates (important events)

Enumeration Date: 12/08/2017
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 NEWPORT BLVD STE 110
COSTA MESA CA
92627-7762
US

IV. Provider business mailing address

1640 NEWPORT BLVD STE 110
COSTA MESA CA
92627-7762
US

V. Phone/Fax

Practice location:
  • Phone: 925-282-1778
  • Fax: 415-296-5299
Mailing address:
  • Phone: 925-282-1778
  • Fax: 415-296-5299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number132132
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8764-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: