Provider Demographics
NPI:1780866913
Name:YOKOTA, TRAVIS NORIO (MS)
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:NORIO
Last Name:YOKOTA
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60534
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-6017
Mailing Address - Country:US
Mailing Address - Phone:949-228-4250
Mailing Address - Fax:
Practice Address - Street 1:14795 JEFFREY RD.
Practice Address - Street 2:SUITE 204
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618
Practice Address - Country:US
Practice Address - Phone:949-228-4250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40484106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist