Individual
MAKOTO WAKAMORI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6618 W CHICKASAW ST, PHOENIX, AZ 85043-5755
(623) 695-7663
Mailing address
6618 W CHICKASAW ST, PHOENIX, AZ 85043-5755
(602) 345-0240
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC-10550
AZ
101YP2500X
Professional Counselor
LPC10550
AZ
Other
Enumeration date
01/06/2015
Last updated
06/30/2025
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