Provider Demographics
NPI:1972360410
Name:HURLEBAUS, MIRANDA (MA, AMFT)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:HURLEBAUS
Suffix:
Gender:F
Credentials:MA, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5256 NOBLE AVE
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-3906
Mailing Address - Country:US
Mailing Address - Phone:507-398-6389
Mailing Address - Fax:
Practice Address - Street 1:17000 VENTURA BLVD STE 210
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-4153
Practice Address - Country:US
Practice Address - Phone:818-570-1805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA145368106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist