Provider Demographics
NPI:1396875654
Name:ZINN, MITCHELL D (MFT)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:D
Last Name:ZINN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1565 HOTEL CIR S
Mailing Address - Street 2:SUITE 350
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3416
Mailing Address - Country:US
Mailing Address - Phone:619-851-5955
Mailing Address - Fax:
Practice Address - Street 1:1565 HOTEL CIR S
Practice Address - Street 2:SUITE 350
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3416
Practice Address - Country:US
Practice Address - Phone:619-851-5955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT35764106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist