Provider Demographics
NPI:1205545910
Name:CHISATO KOMATSU PSYCHOLOGY INC.
Entity type:Organization
Organization Name:CHISATO KOMATSU PSYCHOLOGY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHISATO
Authorized Official - Middle Name:
Authorized Official - Last Name:KOMATSU
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCBA-D
Authorized Official - Phone:213-407-9048
Mailing Address - Street 1:6210 BRISTOL PKWY APT 206
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6925
Mailing Address - Country:US
Mailing Address - Phone:213-407-9048
Mailing Address - Fax:
Practice Address - Street 1:6210 BRISTOL PKWY APT 206
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6925
Practice Address - Country:US
Practice Address - Phone:213-407-9048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health