Provider Demographics
NPI:1982296646
Name:IMAMURA, KAYO (AMFT)
Entity type:Individual
Prefix:
First Name:KAYO
Middle Name:
Last Name:IMAMURA
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:KAYO
Other - Middle Name:
Other - Last Name:IMAMURA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:3274 VIA MARIN
Mailing Address - Street 2:UNITE 87
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-2906
Mailing Address - Country:US
Mailing Address - Phone:858-848-5492
Mailing Address - Fax:
Practice Address - Street 1:3274 VIA MARIN
Practice Address - Street 2:UNITE 87
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-2906
Practice Address - Country:US
Practice Address - Phone:858-848-5492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-04
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA117374106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist