Healthcare Provider Details

I. General information

NPI: 1346602174
Provider Name (Legal Business Name): AMY MUNDELLO LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1351 GEER RD STE 107
TURLOCK CA
95380-3269
US

IV. Provider business mailing address

PO BOX 139
DENAIR CA
95316-0139
US

V. Phone/Fax

Practice location:
  • Phone: 209-427-5610
  • Fax:
Mailing address:
  • Phone: 209-613-3478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number108619
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: