Provider Demographics
NPI:1699975813
Name:VITTE, MIA (MA, MFT)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:VITTE
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 S ELM DR APT 1
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4628
Mailing Address - Country:US
Mailing Address - Phone:310-272-6666
Mailing Address - Fax:
Practice Address - Street 1:11847 BALBOA BLVD
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-2754
Practice Address - Country:US
Practice Address - Phone:747-300-2379
Practice Address - Fax:747-300-2379
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist