Provider Demographics
NPI:1699223545
Name:YANAGAWA, AMY KEEZER (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:KEEZER
Last Name:YANAGAWA
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 CAMBRIDGE AVE STE 23
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1608
Mailing Address - Country:US
Mailing Address - Phone:707-843-0347
Mailing Address - Fax:
Practice Address - Street 1:415 CAMBRIDGE AVE STE 23
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1608
Practice Address - Country:US
Practice Address - Phone:707-843-0347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-20
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83694106H00000X
LMFT 83694106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist