Provider Demographics
NPI:1164556270
Name:OHTA, RENEE A (MFTI)
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:A
Last Name:OHTA
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1243 S DUNSMUIR AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-2632
Mailing Address - Country:US
Mailing Address - Phone:310-382-7667
Mailing Address - Fax:
Practice Address - Street 1:3320 W ADAMS BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-1838
Practice Address - Country:US
Practice Address - Phone:323-596-2480
Practice Address - Fax:323-596-2487
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39243106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist