Healthcare Provider Details

I. General information

NPI: 1861883456
Provider Name (Legal Business Name): MINA NAVAEI LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2015
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 MORSE AVE STE 300
PLACENTIA CA
92870-3504
US

IV. Provider business mailing address

714 MORSE AVE
PLACENTIA CA
92870-3504
US

V. Phone/Fax

Practice location:
  • Phone: 714-617-4886
  • Fax:
Mailing address:
  • Phone: 714-617-4886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number105403
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: