Provider Demographics
NPI:1770286437
Name:SUMIYASU, JILL ANNE DAWSON (LMFT)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:ANNE DAWSON
Last Name:SUMIYASU
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 1:118 W BONITA AVE
Mailing Address - Street 2:
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91024-2412
Mailing Address - Country:US
Mailing Address - Phone:626-524-9494
Mailing Address - Fax:
Practice Address - Street 1:117 E COLORADO BLVD STE 425
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3729
Practice Address - Country:US
Practice Address - Phone:626-720-4677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA137796106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist