Provider Demographics
NPI:1386359867
Name:SCOTT, KATIE MIRANDA (LMFT)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:MIRANDA
Last Name:SCOTT
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 1:3306 EAGLE CREST DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-4074
Mailing Address - Country:US
Mailing Address - Phone:951-233-4197
Mailing Address - Fax:
Practice Address - Street 1:12821 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2711
Practice Address - Country:US
Practice Address - Phone:951-233-4197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133562106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist