Provider Demographics
NPI:1063665214
Name:URAM, MICHAEL J (MA, LMFT, LPCC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:URAM
Suffix:
Gender:M
Credentials:MA, LMFT, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 QUAIL ST STE 155
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2765
Mailing Address - Country:US
Mailing Address - Phone:949-777-6694
Mailing Address - Fax:949-242-2222
Practice Address - Street 1:1000 QUAIL ST STE 155
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2765
Practice Address - Country:US
Practice Address - Phone:949-777-6694
Practice Address - Fax:949-242-2222
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-01
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45428106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist