Healthcare Provider Details

I. General information

NPI: 1578257630
Provider Name (Legal Business Name): TYLER HAKOMORI LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 N BARRANCA AVE # 6163
COVINA CA
91723-1722
US

IV. Provider business mailing address

440 N BARRANCA AVE # 6163
COVINA CA
91723-1722
US

V. Phone/Fax

Practice location:
  • Phone: 626-244-7114
  • Fax:
Mailing address:
  • Phone: 626-244-7114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number164532
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: