Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Ethan C Mandelkern

Individual provider Professional Counselor · NPI 1023224623

Ethan C Mandelkern is a Professional Counselor in Mount Shasta, California. Practices as a sole proprietor. Licensed in California.

Licensed in
CA
In the registry since
2007
Specialties on file
2

Practice location Address checks out

419 Chestnut St Ste #2
Mount Shasta, CA 96067-2918
Phone: (530) 918-8348
Fax: (530) 918-5477
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence LCSW64679 (CA)
Professional Counselor Taxonomy 101YP2500X · Licence LPCC726 (CA)

Record details

NPI number1023224623
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedMay 14, 2007
Last updated in NPPESAugust 12, 2024
Certification dateAugust 12, 2024
Mailing address419 Chestnut St, Suite #2, Mount Shasta, CA 96067-2918

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