Healthcare Provider Details

I. General information

NPI: 1366635526
Provider Name (Legal Business Name): LA TANYA ALICIA TAKLA EDD, LMFT, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. LA TANYA ALICIA TRAILER

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1343 MAGNOLIA AVE
MODESTO CA
95350-5249
US

IV. Provider business mailing address

1343 MAGNOLIA AVE
MODESTO CA
95350-5249
US

V. Phone/Fax

Practice location:
  • Phone: 916-642-9522
  • Fax: 916-234-5056
Mailing address:
  • Phone: 916-642-9522
  • Fax: 916-234-5056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number32391
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: