Provider Demographics
NPI:1568084986
Name:TAKAHASHI, COLIN KAZ (MMFT, LMFT)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:KAZ
Last Name:TAKAHASHI
Suffix:
Gender:M
Credentials:MMFT, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 S PACIFIC COAST HWY STE F
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-4987
Mailing Address - Country:US
Mailing Address - Phone:310-853-0650
Mailing Address - Fax:
Practice Address - Street 1:1200 S PACIFIC COAST HWY STE F
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-4987
Practice Address - Country:US
Practice Address - Phone:310-853-0650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-07
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT132375106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist