Provider Demographics
NPI:1144347188
Name:MIURA, KATHERINE MICHIKO (MFT)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:MICHIKO
Last Name:MIURA
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 1:1849 SAWTELLE BLVD STE 610
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-7013
Mailing Address - Country:US
Mailing Address - Phone:626-483-4607
Mailing Address - Fax:855-450-2166
Practice Address - Street 1:4465 SAINT FRANCIS PL
Practice Address - Street 2:
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-3128
Practice Address - Country:US
Practice Address - Phone:626-483-4607
Practice Address - Fax:626-483-4607
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2024-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47050106H00000X
CAMFC 47050106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7565AOtherOUTPATIENT MENTAL HEALTH