MEDICARE: MS. KATHERINE MICHIKO MIURA MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	47050	CA
2	106H00000X	Marriage & Family Therapist	MFC 47050	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7565A	OTHER	CA	OUTPATIENT MENTAL HEALTH

General Provider Information

NPI Number	:	1144347188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHERINE MICHIKO MIURA MFT

Provider Business Mailing Address
First Line	:	1849 SAWTELLE BLVD STE 610
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-7013
Country	:	US
Telephone Number	:	626-483-4607
Fax Number	:	855-450-2166

Provider Business Practice Location Address
First Line	:	4465 SAINT FRANCIS PL
Second Line	:
City	:	LA CANADA
State	:	CA
Zip	:	91011-3128
Country	:	US
Telephone Number	:	626-483-4607
Fax Number	:	626-483-4607

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	02/11/2024

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