Provider Demographics
NPI:1649693508
Name:TAKAOKA, MARK M (MA, LMFTA)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:M
Last Name:TAKAOKA
Suffix:
Gender:M
Credentials:MA, LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36250 SR 20, SUITE 203
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-0569
Mailing Address - Country:US
Mailing Address - Phone:360-682-6499
Mailing Address - Fax:360-682-4696
Practice Address - Street 1:32650 SR 20 SUITE 203
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277
Practice Address - Country:US
Practice Address - Phone:360-682-6499
Practice Address - Fax:360-682-4696
Is Sole Proprietor?:No
Enumeration Date:2014-01-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60573141101Y00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor