1811122294 NPI number — MRS. THEA MONYEE WINKLER LMFT

Table of content: MRS. THEA MONYEE WINKLER LMFT (NPI 1811122294)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811122294 NPI number — MRS. THEA MONYEE WINKLER LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WINKLER
Provider First Name:
THEA
Provider Middle Name:
MONYEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GRIFFITH-WILSON
Provider Other First Name:
THEA
Provider Other Middle Name:
MONYEE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMFT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1811122294
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 8172
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-902-6237
Provider Business Mailing Address Fax Number:
323-733-3522

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3605 LONG BEACH BLVD
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90807-4013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-427-2006
Provider Business Practice Location Address Fax Number:
562-427-2201
Provider Enumeration Date:
05/28/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: LMFT83623 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)