Healthcare Provider Details

I. General information

NPI: 1982966131
Provider Name (Legal Business Name): KAREN M SMIRL MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 06/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

366 SAN MIGUEL DR STE 309
NEWPORT BEACH CA
92660-7810
US

IV. Provider business mailing address

366 SAN MIGUEL DR STE 309
NEWPORT BEACH CA
92660-7810
US

V. Phone/Fax

Practice location:
  • Phone: 949-721-0144
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT35336
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: