Provider Demographics
NPI:1649308024
Name:MYATT, MJ (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MJ
Middle Name:
Last Name:MYATT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MJ
Other - Middle Name:MYATT
Other - Last Name:LOUGHRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:935 MIDDLEFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301
Mailing Address - Country:US
Mailing Address - Phone:650-520-8089
Mailing Address - Fax:650-326-1260
Practice Address - Street 1:935 MIDDLEFIELD ROAD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301
Practice Address - Country:US
Practice Address - Phone:650-520-8089
Practice Address - Fax:650-326-1260
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8358101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health