Provider Demographics
NPI:1215379532
Name:TAKESHITA DOTY, KRISTINE EMIKO (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:EMIKO
Last Name:TAKESHITA DOTY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:EMI
Other - Middle Name:
Other - Last Name:TAKESHITA DOTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1226 W SAMPLE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-2029
Mailing Address - Country:US
Mailing Address - Phone:650-283-1011
Mailing Address - Fax:
Practice Address - Street 1:4409 E INYO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93702
Practice Address - Country:US
Practice Address - Phone:559-600-4645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-28
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87582106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist