Provider Demographics
NPI:1790306587
Name:JEDEIKIN, MIRI (LMFT)
Entity Type:Individual
Prefix:
First Name:MIRI
Middle Name:
Last Name:JEDEIKIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:MIRIAM
Other - Middle Name:HELEN
Other - Last Name:JEDEIKIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:1923 1/2 WESTWOOD BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-8401
Mailing Address - Country:US
Mailing Address - Phone:310-627-1499
Mailing Address - Fax:
Practice Address - Street 1:1923 1/2 WESTWOOD BLVD STE 2
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-8401
Practice Address - Country:US
Practice Address - Phone:310-800-0012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-03
Last Update Date:2023-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA136243106H00000X
CA118754106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist