Healthcare Provider Details

I. General information

NPI: 1154450419
Provider Name (Legal Business Name): PAMELA J MRAZEK LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12304 SANTA MONICA BLVD STE 212
LOS ANGELES CA
90025-2587
US

IV. Provider business mailing address

2632 WILSHIRE BLVD # 785
SANTA MONICA CA
90403-4623
US

V. Phone/Fax

Practice location:
  • Phone: 424-382-8765
  • Fax:
Mailing address:
  • Phone: 424-382-8765
  • Fax: 760-924-2482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number24576
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT24575
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: