Healthcare Provider Details

I. General information

NPI: 1609952985
Provider Name (Legal Business Name): SHARON J KINARD MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2006
Last Update Date: 02/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15082 ROSECRANS AVE
LA MIRADA CA
90638-4741
US

IV. Provider business mailing address

15082 ROSECRANS AVE
LA MIRADA CA
90638-4741
US

V. Phone/Fax

Practice location:
  • Phone: 741-521-9724
  • Fax: 714-521-9724
Mailing address:
  • Phone: 714-521-9724
  • Fax: 714-521-4724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMX02498
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: