Healthcare Provider Details

I. General information

NPI: 1962741645
Provider Name (Legal Business Name): CHARNA MICHELLE MINTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2013
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13525 32ND AVE NE SUITE A
SEATTLE WA
98125-8613
US

IV. Provider business mailing address

901 N MONROE ST. SUITE 200
SPOKANE WA
99201-2148
US

V. Phone/Fax

Practice location:
  • Phone: 206-365-0809
  • Fax: 206-365-0872
Mailing address:
  • Phone: 509-328-2740
  • Fax: 509-328-0773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: