Healthcare Provider Details

I. General information

NPI: 1225707540
Provider Name (Legal Business Name): FRIENDLY TALK THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 30TH ST STE 311
SACRAMENTO CA
95816-3359
US

IV. Provider business mailing address

5412 V ST
SACRAMENTO CA
95817-1658
US

V. Phone/Fax

Practice location:
  • Phone: 916-844-2517
  • Fax:
Mailing address:
  • Phone: 916-346-9451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PETER-NAM HOANG DINH
Title or Position: CEO
Credential: LMFT
Phone: 916-844-2517