Provider Demographics
NPI:1902969405
Name:SKOUTELAKIS, MINA ALEXANDRA (MFT)
Entity Type:Individual
Prefix:MRS
First Name:MINA
Middle Name:ALEXANDRA
Last Name:SKOUTELAKIS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:699 PETERS AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-6579
Mailing Address - Country:US
Mailing Address - Phone:925-216-6561
Mailing Address - Fax:
Practice Address - Street 1:699 PETERS AVE STE A
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-6579
Practice Address - Country:US
Practice Address - Phone:925-216-6561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 40793106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist