Healthcare Provider Details

I. General information

NPI: 1356697429
Provider Name (Legal Business Name): MIREYA CORONA M.A., LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2012
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 N HOLLYWOOD WAY # 6241
BURBANK CA
91510-8217
US

IV. Provider business mailing address

2140 N HOLLYWOOD WAY # 6241
BURBANK CA
91510-8217
US

V. Phone/Fax

Practice location:
  • Phone: 323-612-8055
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number97025
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: