Provider Demographics
NPI:1891114187
Name:TSUKAMAKI, PATRICK WILLIAM (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:WILLIAM
Last Name:TSUKAMAKI
Suffix:
Gender:M
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 1:395 TAYLOR BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2291
Mailing Address - Country:US
Mailing Address - Phone:925-289-9245
Mailing Address - Fax:
Practice Address - Street 1:395 TAYLOR BLVD STE 220
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2291
Practice Address - Country:US
Practice Address - Phone:925-289-9245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT 91097106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist