Provider Demographics
NPI:1801935432
Name:SUDANI, KEIKO (MA, MFT)
Entity type:Individual
Prefix:MS
First Name:KEIKO
Middle Name:
Last Name:SUDANI
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 N GRAND AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-1752
Mailing Address - Country:US
Mailing Address - Phone:626-915-2110
Mailing Address - Fax:626-570-8020
Practice Address - Street 1:150 N GRAND AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-1752
Practice Address - Country:US
Practice Address - Phone:626-915-2110
Practice Address - Fax:626-570-8020
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42321106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist