MEDICARE: VIRGINIA A MINTZLAFF M.S.,LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC41854	CA

General Provider Information

NPI Number	:	1174659676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGINIA A MINTZLAFF M.S.,LMFT

Provider Business Mailing Address
First Line	:	128 E KATELLA AVE
Second Line	:	SUITE 200
City	:	ORANGE
State	:	CA
Zip	:	92867-4836
Country	:	US
Telephone Number	:	714-292-2292
Fax Number	:	714-771-9710

Provider Business Practice Location Address
First Line	:	128 E KATELLA AVE
Second Line	:	SUITE 200
City	:	ORANGE
State	:	CA
Zip	:	92867-4836
Country	:	US
Telephone Number	:	714-292-2292
Fax Number	:	714-771-9710

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	07/08/2007

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