Provider Demographics
NPI:1558851253
Name:MALY-KARROS, MIKAH (AMFT)
Entity Type:Individual
Prefix:
First Name:MIKAH
Middle Name:
Last Name:MALY-KARROS
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 LARRABEE ST APT 6
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-2176
Mailing Address - Country:US
Mailing Address - Phone:310-721-9533
Mailing Address - Fax:
Practice Address - Street 1:1223 LARRABEE ST APT 6
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-2176
Practice Address - Country:US
Practice Address - Phone:310-721-9533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83849106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist