Provider Demographics
NPI:1679121354
Name:MINTY, SODAH
Entity type:Individual
Prefix:
First Name:SODAH
Middle Name:
Last Name:MINTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SAUDAH
Other - Middle Name:
Other - Last Name:MINTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10125 DE SOTO AVE UNIT 6
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-3238
Mailing Address - Country:US
Mailing Address - Phone:805-746-0599
Mailing Address - Fax:
Practice Address - Street 1:221 WESTWOOD PLAZA CAPS JOHN WOODEN CENTER WEST 951556
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-825-0768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health