Provider Demographics
NPI:1720364607
Name:ARAKAWA, TATSUYA (LMFT)
Entity Type:Individual
Prefix:
First Name:TATSUYA
Middle Name:
Last Name:ARAKAWA
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18323 S WESTERN AVE APT 105
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-3854
Mailing Address - Country:US
Mailing Address - Phone:424-254-8823
Mailing Address - Fax:
Practice Address - Street 1:2790 SKYPARK DR STE 102
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5331
Practice Address - Country:US
Practice Address - Phone:424-254-8823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82425106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA190077AHNMedicaid