MEDICARE: MS. MIRIAM ANTHONY LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	136815	CA

General Provider Information

NPI Number	:	1003521527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MIRIAM ANTHONY LMFT

Provider Business Mailing Address
First Line	:	2740 W MAGNOLIA BLVD UNIT 101
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-3050
Country	:	US
Telephone Number	:	707-334-2207
Fax Number	:

Provider Business Practice Location Address
First Line	:	2740 W MAGNOLIA BLVD UNIT 101
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-3050
Country	:	US
Telephone Number	:	707-334-2207
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2023
Last Update Date	:	02/18/2026

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