Healthcare Provider Details

I. General information

NPI: 1891825097
Provider Name (Legal Business Name): MARINA ANNEGRET NAUJOCKS-MIX LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2485 OLD EUREKA WAY
REDDING CA
96001-0336
US

IV. Provider business mailing address

PO BOX 992891
REDDING CA
96099-2891
US

V. Phone/Fax

Practice location:
  • Phone: 530-223-4500
  • Fax: 530-244-1546
Mailing address:
  • Phone: 530-223-4500
  • Fax: 530-244-1546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC35571
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: