Healthcare Provider Details

I. General information

NPI: 1710805767
Provider Name (Legal Business Name): TERYN HARA TSUKAHIRA LICENSED CLINICAL SOCIAL WORKER PROF. CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21515 HAWTHORNE BLVD STE 200
TORRANCE CA
90503-6512
US

IV. Provider business mailing address

21515 HAWTHORNE BLVD STE 200
TORRANCE CA
90503-6512
US

V. Phone/Fax

Practice location:
  • Phone: 424-426-1797
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: TERYN HARA TSUKAHIRA
Title or Position: PRESIDENT
Credential:
Phone: 424-426-1797