Provider Demographics
NPI:1053679308
Name:HOTAKI, TANYA M (MFT)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:M
Last Name:HOTAKI
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 SERRANIA AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-3301
Mailing Address - Country:US
Mailing Address - Phone:818-857-5939
Mailing Address - Fax:
Practice Address - Street 1:15455 SAN FERNANDO MISSION BLVD
Practice Address - Street 2:STE 308
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1300
Practice Address - Country:US
Practice Address - Phone:818-657-3141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT90951106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist