Healthcare Provider Details

I. General information

NPI: 1477756344
Provider Name (Legal Business Name): MICHAELA EVA TORK LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11795 LAURELCREST DR
STUDIO CITY CA
91604-3816
US

IV. Provider business mailing address

11795 LAURELCREST DR
STUDIO CITY CA
91604-3816
US

V. Phone/Fax

Practice location:
  • Phone: 818-760-1372
  • Fax: 888-302-9280
Mailing address:
  • Phone: 818-760-1372
  • Fax: 888-302-9280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLMFT 46882
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: