Provider Demographics
NPI:1326207036
Name:MILLS, JONATHAN KENDALL (LMFT)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:KENDALL
Last Name:MILLS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17671 ROBUSTA DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-7068
Mailing Address - Country:US
Mailing Address - Phone:951-833-6000
Mailing Address - Fax:951-509-0703
Practice Address - Street 1:4620 PINE ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-4007
Practice Address - Country:US
Practice Address - Phone:951-833-1527
Practice Address - Fax:951-509-0703
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 41885106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist