Provider Demographics
NPI:1942656798
Name:IKEMOTO-JOSEPH, REIKO LAUREN (LMFT)
Entity Type:Individual
Prefix:MS
First Name:REIKO
Middle Name:LAUREN
Last Name:IKEMOTO-JOSEPH
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 1:745 S MARENGO AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-4735
Mailing Address - Country:US
Mailing Address - Phone:323-320-4103
Mailing Address - Fax:
Practice Address - Street 1:745 S MARENGO AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-4735
Practice Address - Country:US
Practice Address - Phone:323-320-4103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88531106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist