Provider Demographics
NPI:1164216958
Name:HINES, MISCHA LENORE (LMFT)
Entity type:Individual
Prefix:
First Name:MISCHA
Middle Name:LENORE
Last Name:HINES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13351 RIVERSIDE DR # 283
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-2542
Mailing Address - Country:US
Mailing Address - Phone:818-635-0408
Mailing Address - Fax:
Practice Address - Street 1:5107 COLDWATER CANYON AVE UNIT 3
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-1693
Practice Address - Country:US
Practice Address - Phone:818-916-2413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA154317106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist