Healthcare Provider Details

I. General information

NPI: 1992846083
Provider Name (Legal Business Name): MICHIYO OKANO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8616 LA TIJERA BLVD #200
LOS ANGELES CA
90045-3944
US

IV. Provider business mailing address

8616 LA TIJERA BLVD #200
LOS ANGELES CA
90045-3944
US

V. Phone/Fax

Practice location:
  • Phone: 310-337-1550
  • Fax: 310-337-2805
Mailing address:
  • Phone: 310-337-1550
  • Fax: 310-337-2805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6574
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: