Healthcare Provider Details

I. General information

NPI: 1700409638
Provider Name (Legal Business Name): URAM FAMILY THERAPY PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2020
Last Update Date: 05/27/2020
Certification Date: 05/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 QUAIL ST STE 155
NEWPORT BEACH CA
92660-2765
US

IV. Provider business mailing address

1000 QUAIL ST STE 155
NEWPORT BEACH CA
92660-2765
US

V. Phone/Fax

Practice location:
  • Phone: 949-777-6694
  • Fax: 949-242-2222
Mailing address:
  • Phone: 949-777-6694
  • Fax: 949-242-2222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL JOHN URAM
Title or Position: OWNER
Credential: MA, LMFT, LPCC
Phone: 949-777-6694