Healthcare Provider Details

I. General information

NPI: 1417542747
Provider Name (Legal Business Name): ALISA MARIE ANHOLD-TUNG LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N CIVIC DR STE 183
WALNUT CREEK CA
94596-3864
US

IV. Provider business mailing address

3835 N FREEWAY BLVD STE 100
SACRAMENTO CA
95834-1954
US

V. Phone/Fax

Practice location:
  • Phone: 925-299-9033
  • Fax: 925-299-9030
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number149609
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: