Healthcare Provider Details

I. General information

NPI: 1053679308
Provider Name (Legal Business Name): TANYA M HOTAKI MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 03/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15455 SAN FERNANDO MISSION BLVD STE 308
MISSION HILLS CA
91345-1300
US

IV. Provider business mailing address

4900 SERRANIA AVE
WOODLAND HILLS CA
91364-3301
US

V. Phone/Fax

Practice location:
  • Phone: 818-657-3141
  • Fax:
Mailing address:
  • Phone: 818-857-5939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT90951
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: