Provider Demographics
NPI:1184384604
Name:HUNTER, MIRIAM MIMI (LMFT)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:MIMI
Last Name:HUNTER
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:PO BOX 602
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-0602
Mailing Address - Country:US
Mailing Address - Phone:310-430-3260
Mailing Address - Fax:
Practice Address - Street 1:11911 SAN VICENTE BLVD STE 280
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-6611
Practice Address - Country:US
Practice Address - Phone:310-430-3260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26035106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty