Healthcare Provider Details

I. General information

NPI: 1821956095
Provider Name (Legal Business Name): MIRANDA YORK LMFT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5661 KEITH AVE
OAKLAND CA
94618-1542
US

IV. Provider business mailing address

3434 S KELLY AVE
PORTLAND OR
97239-4630
US

V. Phone/Fax

Practice location:
  • Phone: 206-683-6637
  • Fax:
Mailing address:
  • Phone: 415-799-3730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL

VIII. Authorized Official

Name: MIRANDA BLYTHE YORK
Title or Position: PRESIDENT
Credential: LMFT
Phone: 206-683-6637