Provider Demographics
NPI:1750606836
Name:KOENIG, MIRIAM I (MFT)
Entity type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:I
Last Name:KOENIG
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5535 BALBOA BLVD.
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1545
Mailing Address - Country:US
Mailing Address - Phone:818-783-4032
Mailing Address - Fax:
Practice Address - Street 1:5535 BALBOA BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1516
Practice Address - Country:US
Practice Address - Phone:818-783-4032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT29857106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist