Provider Demographics
NPI:1346913944
Name:MIYATA, HITOSHI (LLPC)
Entity Type:Individual
Prefix:MR
First Name:HITOSHI
Middle Name:
Last Name:MIYATA
Suffix:
Gender:M
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 NILES AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-1615
Mailing Address - Country:US
Mailing Address - Phone:269-982-7200
Mailing Address - Fax:269-982-0202
Practice Address - Street 1:1901 NILES AVE STE 102
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-1615
Practice Address - Country:US
Practice Address - Phone:269-982-7200
Practice Address - Fax:269-982-0202
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401017918101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional