Provider Demographics
NPI:1821322645
Name:TSUCHIMOTO, MIE LYNN (LMFT)
Entity Type:Individual
Prefix:
First Name:MIE
Middle Name:LYNN
Last Name:TSUCHIMOTO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27126 PASEO ESPADA
Mailing Address - Street 2:SUITE 722
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-2721
Mailing Address - Country:US
Mailing Address - Phone:949-429-8899
Mailing Address - Fax:949-429-8898
Practice Address - Street 1:27126 PASEO ESPADA
Practice Address - Street 2:SUITE 722
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-2721
Practice Address - Country:US
Practice Address - Phone:949-429-8899
Practice Address - Fax:949-429-8898
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 44181106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist