Provider Demographics
NPI:1063025286
Name:KENT, MIRANDA CATHRYN (LMFT)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:CATHRYN
Last Name:KENT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 CROSBY ST
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-5429
Mailing Address - Country:US
Mailing Address - Phone:323-274-9555
Mailing Address - Fax:
Practice Address - Street 1:508 CROSBY ST
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-5429
Practice Address - Country:US
Practice Address - Phone:323-229-3590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-27
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA121002101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health