Provider Demographics
NPI:1477091841
Name:BLAKELY-BROWN, MIA CATHERINE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MIA
Middle Name:CATHERINE
Last Name:BLAKELY-BROWN
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 1:595 E COLORADO BLVD STE 423
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2018
Mailing Address - Country:US
Mailing Address - Phone:818-538-9855
Mailing Address - Fax:877-706-2228
Practice Address - Street 1:595 E COLORADO BLVD STE 423
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2018
Practice Address - Country:US
Practice Address - Phone:818-538-9855
Practice Address - Fax:877-706-2228
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-06
Last Update Date:2023-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT96145106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist