Healthcare Provider Details

I. General information

NPI: 1134751845
Provider Name (Legal Business Name): MICHAEL BRADFORD MORAR PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2020
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3580 WILSHIRE BLVD STE 2000
LOS ANGELES CA
90010-2533
US

IV. Provider business mailing address

13924 MARQUESAS WAY APT 1315
MARINA DEL REY CA
90292-6015
US

V. Phone/Fax

Practice location:
  • Phone: 213-381-1250
  • Fax:
Mailing address:
  • Phone: 949-355-5679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number83490
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number127246
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: