Healthcare Provider Details

I. General information

NPI: 1265180335
Provider Name (Legal Business Name): ZOE MAHEALANI SPEARS-TAKAKUWA LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2022
Last Update Date: 02/17/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12340 SANTA MONICA BLVD STE 214
LOS ANGELES CA
90025-2594
US

IV. Provider business mailing address

12340 SANTA MONICA BLVD STE 214
LOS ANGELES CA
90025-2594
US

V. Phone/Fax

Practice location:
  • Phone: 310-582-1513
  • Fax:
Mailing address:
  • Phone: 310-582-1513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number118502
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number137699
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: