Provider Demographics
NPI:1508157694
Name:TRAGESER, MIVEN BOOTH (LMFT, LPCC)
Entity Type:Individual
Prefix:
First Name:MIVEN
Middle Name:BOOTH
Last Name:TRAGESER
Suffix:
Gender:F
Credentials:LMFT, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6310 SAN VICENTE BLVD,
Mailing Address - Street 2:SUITE 415
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5426
Mailing Address - Country:US
Mailing Address - Phone:323-813-8238
Mailing Address - Fax:310-861-1441
Practice Address - Street 1:6310 SAN VICENTE BLVD.
Practice Address - Street 2:SUITE 415
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5426
Practice Address - Country:US
Practice Address - Phone:310-284-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1339101YP2500X
CA49725106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional