Provider Demographics
NPI:1316361991
Name:MIKAWA, TOMOMI (LMFT)
Entity Type:Individual
Prefix:MS
First Name:TOMOMI
Middle Name:
Last Name:MIKAWA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 FOOTHILL BLVD UNIT 261
Mailing Address - Street 2:
Mailing Address - City:LA CANADA FLINTRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91012-7013
Mailing Address - Country:US
Mailing Address - Phone:310-626-0064
Mailing Address - Fax:
Practice Address - Street 1:1910 HUNTINGTON DR UNIT 13
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-4887
Practice Address - Country:US
Practice Address - Phone:310-626-0064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC86499106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist