Healthcare Provider Details

I. General information

NPI: 1376816041
Provider Name (Legal Business Name): MYNDA DANYEL OHS MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2012
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7916 VIA OBRA CT
HIGHLAND CA
92346-6310
US

IV. Provider business mailing address

1706 PLUM LN 114
REDLANDS CA
92374-4576
US

V. Phone/Fax

Practice location:
  • Phone: 909-214-5445
  • Fax:
Mailing address:
  • Phone: 909-663-7399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number50291
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: