Provider Demographics
NPI:1528190824
Name:MIYAOKA, DOROTHY MARIE (LMFT)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:MARIE
Last Name:MIYAOKA
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 1:24331 MUIRLANDS BLVD., STE. D, BOX 203
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-3689
Mailing Address - Country:US
Mailing Address - Phone:949-246-0551
Mailing Address - Fax:
Practice Address - Street 1:1151 DOVE ST STE 105
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2805
Practice Address - Country:US
Practice Address - Phone:949-246-0551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT77992106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist