Provider Demographics
NPI:1457197840
Name:MIYOSHI, MADELINE (LMFT)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:MIYOSHI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:MADDIE
Other - Middle Name:
Other - Last Name:MIYOSHI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:12301 NAVY ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-1048
Mailing Address - Country:US
Mailing Address - Phone:310-245-3411
Mailing Address - Fax:
Practice Address - Street 1:13101 W WASHINGTON BLVD STE 233
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-8128
Practice Address - Country:US
Practice Address - Phone:310-245-3411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA147753106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist