Mira Walters

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

80869 Issued in CA

Practice address

222 W Main St
203
Tustin, CA 92780-7720

Phone

(714) 651-7753

NPI assigned

Jul 17, 2014

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ball and Brosch Counseling Services: Marriage, Family, & Child

  • Marriage & Family Therapist
  • Santa Ana, CA
  • NPI 1770990624
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1405555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405555200000",
    "number": "1699182055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 W MAIN ST",
            "address_2": "203",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927807720",
            "telephone_number": "714-651-7753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 W MAIN ST",
            "address_2": "203",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927807720",
            "telephone_number": "714-651-7753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "MIRA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-07-17",
        "last_updated": "2014-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "80869",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co (Walgreens #07286)
• Leiza Yamila Walia, D.M.D.
• Chris Walker, B.A.
• Dixie Shannon Wall
• Jennifer Eileen Walsvick, LCSW
• Susan Adele Walters, MFT
• Francis Wang
• Helen Wang
• Hsing-an Daisy Wang, BCBA
• Lisa Wang

• Marriage & Family Therapist in Tustin, CA
• Providers in Tustin, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.