Healthcare Provider Details

I. General information

NPI: 1336819564
Provider Name (Legal Business Name): LA TANYA TAKLA, PSYCHOLOGIST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2021
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 TaxonomyN
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. LA TANYA ALICIA TAKLA
Title or Position: OWNER/LICENSE CLINICAL PSYCHOLOGIST
Credential: EDD
Phone: 916-642-9522