Provider Demographics
NPI:1144115643
Name:SHIROMA, MINDY LYNN JOHANNA (PPS)
Entity type:Individual
Prefix:MRS
First Name:MINDY LYNN
Middle Name:JOHANNA
Last Name:SHIROMA
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:MS
Other - First Name:MINDY LYNN
Other - Middle Name:JOHANNA
Other - Last Name:TAYET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PPS
Mailing Address - Street 1:1401 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-2523
Mailing Address - Country:US
Mailing Address - Phone:657-321-4000
Mailing Address - Fax:
Practice Address - Street 1:1401 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-2523
Practice Address - Country:US
Practice Address - Phone:657-321-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220103449101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool