Provider Demographics
NPI:1548152630
Name:LAM, MINDY
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:LAM
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6702 TRIGO RD APT 4
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-4919
Mailing Address - Country:US
Mailing Address - Phone:760-300-5570
Mailing Address - Fax:
Practice Address - Street 1:195 S BROADWAY ST STE 205
Practice Address - Street 2:
Practice Address - City:ORCUTT
Practice Address - State:CA
Practice Address - Zip Code:93455-4656
Practice Address - Country:US
Practice Address - Phone:760-300-5570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician