Healthcare Provider Details

I. General information

NPI: 1679095582
Provider Name (Legal Business Name): HANA GO PSYD, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3031 S VERMONT AVE
LOS ANGELES CA
90007-3033
US

IV. Provider business mailing address

200 N VERMONT AVE APT 401
LOS ANGELES CA
90004-4989
US

V. Phone/Fax

Practice location:
  • Phone: 323-766-2345
  • Fax:
Mailing address:
  • Phone: 323-328-6253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number94027461
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number126395
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: