1417322041 NPI number — ERNA C MILLS LMFT

Table of content: ERNA C MILLS LMFT (NPI 1417322041)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417322041 NPI number — ERNA C MILLS LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLS
Provider First Name:
ERNA
Provider Middle Name:
C
Provider Name Prefix Text:
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:
CASTREJON ALVAREZ
Provider Other First Name:
ERNA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMFT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1417322041
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5638 LAKE MURRAY BLVD # 119
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA MESA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91942-1929
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-224-9972
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2801 CAMINO DEL RIO S STE 204-3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-3800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-402-5569
Provider Business Practice Location Address Fax Number:
877-320-7577
Provider Enumeration Date:
12/08/2015

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:  105892 , 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)