Provider Demographics
NPI:1508132937
Name:KURODA, MEG (MA, MFT)
Entity Type:Individual
Prefix:MS
First Name:MEG
Middle Name:
Last Name:KURODA
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:MS
Other - First Name:MEGUMI
Other - Middle Name:
Other - Last Name:KURODA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, MFT
Mailing Address - Street 1:11850 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6609
Mailing Address - Country:US
Mailing Address - Phone:310-699-2508
Mailing Address - Fax:
Practice Address - Street 1:11850 WILSHIRE BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6609
Practice Address - Country:US
Practice Address - Phone:310-699-2508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC51168106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist