Provider Demographics
NPI:1598836090
Name:MIYAKE, YOSHIKO (MA, CMHC)
Entity Type:Individual
Prefix:
First Name:YOSHIKO
Middle Name:
Last Name:MIYAKE
Suffix:
Gender:F
Credentials:MA, CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3585 N UNIVERSITY AVE BLDG SUITE300
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-6601
Mailing Address - Country:US
Mailing Address - Phone:801-797-1111
Mailing Address - Fax:801-996-0158
Practice Address - Street 1:3585 N UNIVERSITY AVE BLDG SUITE300
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-6601
Practice Address - Country:US
Practice Address - Phone:801-797-1111
Practice Address - Fax:801-996-0158
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00055630101YM0800X
UT6334403-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health