Provider Demographics
NPI:1821283680
Name:MEJIA, MIRYAM NOEMI (LMFT)
Entity Type:Individual
Prefix:MS
First Name:MIRYAM
Middle Name:NOEMI
Last Name:MEJIA
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 1:1771 NOCHEBUENA ST.
Mailing Address - Street 2:
Mailing Address - City:SEASIDE
Mailing Address - State:CA
Mailing Address - Zip Code:98955
Mailing Address - Country:US
Mailing Address - Phone:831-240-8728
Mailing Address - Fax:
Practice Address - Street 1:801 LIGHTHOUSE AVE
Practice Address - Street 2:STE 212
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940
Practice Address - Country:US
Practice Address - Phone:831-240-8728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA51905106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health