=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801217724
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MISHA HENNING LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2013
-----------------------------------------------------
Last Update Date | 05/10/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 82 CALLE ARAGON UNIT R
-----------------------------------------------------
City | LAGUNA WOODS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92637-3921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-393-1219
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 PINE AVE STE 400
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90802-3039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-285-1330
-----------------------------------------------------
Fax | 562-361-4958
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 135133
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------