Healthcare Provider Details

I. General information

NPI: 1548563315
Provider Name (Legal Business Name): YOKO ICHIMURA LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2010
Last Update Date: 08/23/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 E BROADWAY STE 314
LONG BEACH CA
90802-7801
US

IV. Provider business mailing address

11845 W OLYMPIC BLVD STE 1050W
LOS ANGELES CA
90064-5046
US

V. Phone/Fax

Practice location:
  • Phone: 707-408-2519
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8495
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: