Provider Demographics
NPI:1568937282
Name:YORK, MIRANDA BLYTHE (LMFT)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:BLYTHE
Last Name:YORK
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 1:431 30TH ST STE 115A
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3307
Mailing Address - Country:US
Mailing Address - Phone:415-799-3730
Mailing Address - Fax:
Practice Address - Street 1:431 30TH ST STE 115A
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3307
Practice Address - Country:US
Practice Address - Phone:415-799-3730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100415101YM0800X
ORT1469101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health