Healthcare Provider Details

I. General information

NPI: 1427509256
Provider Name (Legal Business Name): MITCHELL POHL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 BARRANCA PKWY STE 200
IRVINE CA
92604-1723
US

IV. Provider business mailing address

4050 BARRANCA PKWY STE 200
IRVINE CA
92604-1723
US

V. Phone/Fax

Practice location:
  • Phone: 877-696-3622
  • Fax: 949-262-5500
Mailing address:
  • Phone: 877-696-3622
  • Fax: 949-262-5500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number117161
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: