Provider Demographics
NPI:1902308877
Name:MINK, JUSTIN (LCSW)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:
Last Name:MINK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13101 W WASHINGTON BLVD STE 226
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-8128
Mailing Address - Country:US
Mailing Address - Phone:424-216-8404
Mailing Address - Fax:
Practice Address - Street 1:13101 W WASHINGTON BLVD STE 226
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-8128
Practice Address - Country:US
Practice Address - Phone:424-216-8404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2024-08-15
Deactivation Date:2024-04-23
Deactivation Code:
Reactivation Date:2024-07-08
Provider Licenses
StateLicense IDTaxonomies
CALCSW889901041C0700X
CAACSW738201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical