1326207036 NPI number — DR. JONATHAN KENDALL MILLS LMFT

Table of content: DR. JONATHAN KENDALL MILLS LMFT (NPI 1326207036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326207036 NPI number — DR. JONATHAN KENDALL MILLS LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLS
Provider First Name:
JONATHAN
Provider Middle Name:
KENDALL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326207036
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17671 ROBUSTA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVERSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92503-7068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-833-6000
Provider Business Mailing Address Fax Number:
951-509-0703

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4620 PINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVERSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92501-4007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-833-1527
Provider Business Practice Location Address Fax Number:
951-509-0703
Provider Enumeration Date:
06/06/2008

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 , with the licence number:  MFC 41885 , 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)





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