Provider Demographics
NPI:1962741645
Name:MINTZ, CHARNA MICHELLE
Entity type:Individual
Prefix:
First Name:CHARNA
Middle Name:MICHELLE
Last Name:MINTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 N MONROE ST.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2148
Mailing Address - Country:US
Mailing Address - Phone:509-328-2740
Mailing Address - Fax:509-328-0773
Practice Address - Street 1:13525 32ND AVE NE
Practice Address - Street 2:SUITE A
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-8613
Practice Address - Country:US
Practice Address - Phone:206-365-0809
Practice Address - Fax:206-365-0872
Is Sole Proprietor?:No
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral