Provider Demographics
NPI:1295538411
Name:MEISENHOLDER, MUGE (AMFT)
Entity type:Individual
Prefix:
First Name:MUGE
Middle Name:
Last Name:MEISENHOLDER
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:MUGE
Other - Middle Name:
Other - Last Name:MEISENHOLDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MUGE UNER
Mailing Address - Street 1:1900 ROYALTY DR STE 180
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-3046
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1900 ROYALTY DR STE 180
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3046
Practice Address - Country:US
Practice Address - Phone:909-766-7364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT148138106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist