Provider Demographics
NPI:1194118786
Name:FLORES, MINDIE LYN (CADC-CAS)
Entity type:Individual
Prefix:MRS
First Name:MINDIE
Middle Name:LYN
Last Name:FLORES
Suffix:
Gender:F
Credentials:CADC-CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:831 E ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-2535
Mailing Address - Country:US
Mailing Address - Phone:909-398-4383
Mailing Address - Fax:909-445-8936
Practice Address - Street 1:4626 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-2055
Practice Address - Country:US
Practice Address - Phone:626-331-5316
Practice Address - Fax:626-332-2219
Is Sole Proprietor?:No
Enumeration Date:2015-03-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC30431214101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)