Provider Demographics
NPI:1639297344
Name:MINAMI, TAKUYA
Entity Type:Individual
Prefix:
First Name:TAKUYA
Middle Name:
Last Name:MINAMI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 EDUCATION BUILDING, 1000 BASCOM MALL
Mailing Address - Street 2:COUNSELING PSYCHOLOGY, UNIVERSITY OF WISCONSIN-MADISON
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53706
Mailing Address - Country:US
Mailing Address - Phone:608-263-3753
Mailing Address - Fax:
Practice Address - Street 1:305 EDUCATION BUILDING, 1000 BASCOM MALL
Practice Address - Street 2:COUNSELING PSYCHOLOGY, UNIVERSITY OF WISCONSIN-MADISON
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53706
Practice Address - Country:US
Practice Address - Phone:608-263-3753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5729247-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist