Healthcare Provider Details

I. General information

NPI: 1588099766
Provider Name (Legal Business Name): ANITA LOUISE MIHECOBY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 W 6TH ST
LOS ANGELES CA
90017-1833
US

IV. Provider business mailing address

4402 LAYMAN AVE
PICO RIVERA CA
90660
US

V. Phone/Fax

Practice location:
  • Phone: 626-430-4521
  • Fax:
Mailing address:
  • Phone: 626-430-4521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number29218
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number29218
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: