Provider Demographics
NPI:1184123200
Name:SON, MIYOUNG (LMFT)
Entity type:Individual
Prefix:MS
First Name:MIYOUNG
Middle Name:
Last Name:SON
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 1:2967 CARLSBAD BLVD
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-2904
Mailing Address - Country:US
Mailing Address - Phone:323-452-1955
Mailing Address - Fax:619-701-6657
Practice Address - Street 1:2967 CARLSBAD BLVD
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-2904
Practice Address - Country:US
Practice Address - Phone:323-452-1955
Practice Address - Fax:619-701-6657
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-04
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CALMFT97293101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty