Provider Demographics
NPI:1285647834
Name:KAWAGUCHI, MYRA CHRISTENSEN (PHD)
Entity Type:Individual
Prefix:MS
First Name:MYRA
Middle Name:CHRISTENSEN
Last Name:KAWAGUCHI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MYRA
Other - Middle Name:JANE
Other - Last Name:CHRISTENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:520 CHARLES AVE
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-2084
Mailing Address - Country:US
Mailing Address - Phone:440-984-4005
Mailing Address - Fax:
Practice Address - Street 1:1740 COOPER FOSTER PARK
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053
Practice Address - Country:US
Practice Address - Phone:440-282-1383
Practice Address - Fax:440-989-1265
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6107103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical