Provider Demographics
NPI:1194439901
Name:OTA, CHERI (AMFT)
Entity type:Individual
Prefix:
First Name:CHERI
Middle Name:
Last Name:OTA
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 E 59TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-3401
Mailing Address - Country:US
Mailing Address - Phone:818-481-6631
Mailing Address - Fax:
Practice Address - Street 1:2900 BRISTOL ST STE J206
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-7921
Practice Address - Country:US
Practice Address - Phone:949-436-7413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA129146106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist