Healthcare Provider Details

I. General information

NPI: 1871435321
Provider Name (Legal Business Name): CALIFORNIA GRIEF THERAPY CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 N COAST HIGHWAY 101
ENCINITAS CA
92024-2542
US

IV. Provider business mailing address

374 N COAST HIGHWAY 101
ENCINITAS CA
92024-2542
US

V. Phone/Fax

Practice location:
  • Phone: 323-366-8208
  • Fax:
Mailing address:
  • Phone: 323-366-8208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. MIRA MASUKAWA
Title or Position: CEO
Credential: LMFT
Phone: 323-366-8208