Provider Demographics
NPI:1154450419
Name:MRAZEK, PAMELA J (LMFT)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:J
Last Name:MRAZEK
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 1:2632 WILSHIRE BLVD # 785
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4623
Mailing Address - Country:US
Mailing Address - Phone:424-382-8765
Mailing Address - Fax:760-924-2482
Practice Address - Street 1:12304 SANTA MONICA BLVD STE 212
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-2587
Practice Address - Country:US
Practice Address - Phone:424-382-8765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24576106H00000X
CAMFT24575106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist