Provider Demographics
NPI:1952008211
Name:OZAWA, MIKAKO (MS, MFT-I)
Entity Type:Individual
Prefix:
First Name:MIKAKO
Middle Name:
Last Name:OZAWA
Suffix:
Gender:F
Credentials:MS, MFT-I
Other - Prefix:
Other - First Name:LUNA
Other - Middle Name:
Other - Last Name:ASAGI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, MFT-I
Mailing Address - Street 1:2298 W HORIZON RIDGE PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2698
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:702-242-5252
Practice Address - Street 1:2298 W HORIZON RIDGE PKWY STE 201
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2698
Practice Address - Country:US
Practice Address - Phone:702-825-0075
Practice Address - Fax:702-242-5252
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-07
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI4193106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist