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General NPI Number Information
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NPI Number | 1972360410
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Entity Type | Individual
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Provider Name | MIRANDA HURLEBAUS MA, AMFT
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Gender | Female
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Dates
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Enumeration Date | 03/01/2024
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Last Update Date | 03/01/2024
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Provider Practice Location Address
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Address Line | 17000 VENTURA BLVD STE 210
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City | ENCINO
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State | CA
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Zip | 91316-4153
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Country | US
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Telephone | 818-570-1805
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Fax |
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Provider Business Mailing Address
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Address Line | 5256 NOBLE AVE
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City | SHERMAN OAKS
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State | CA
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Zip | 91411-3906
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Country | US
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Telephone | 507-398-6389
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 145368
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License Number State | CA
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