Provider Demographics
NPI:1467179044
Name:NAMEKATA, MICHAEL (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:NAMEKATA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 570895
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91357-0895
Mailing Address - Country:US
Mailing Address - Phone:818-254-8125
Mailing Address - Fax:
Practice Address - Street 1:6345 BALBOA BLVD
Practice Address - Street 2:BLDG 1, STE 212
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1517
Practice Address - Country:US
Practice Address - Phone:818-254-8125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY33698103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical