Provider Demographics
NPI:1841695756
Name:MAIKO, MICHAEL SULU JR (LMFT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SULU
Last Name:MAIKO
Suffix:JR
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8616 LA TIJERA BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3945
Mailing Address - Country:US
Mailing Address - Phone:310-337-1550
Mailing Address - Fax:
Practice Address - Street 1:8616 LA TIJERA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3945
Practice Address - Country:US
Practice Address - Phone:310-337-1550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110786101YM0800X
171M00000X
CA128909106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator