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General NPI Number Information
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NPI Number | 1265799951
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Entity Type | Organization
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Legal Business Name | LA TANYA TAKLA
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Dates
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Enumeration Date | 04/18/2012
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Last Update Date | 04/18/2012
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Provider Practice Location Address
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Address Line | 1652 W TEXAS ST SUITE 131
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City | FAIRFIELD
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State | CA
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Zip | 94533-6066
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Country | US
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Telephone | 650-454-6109
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Fax | 650-231-2633
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Provider Business Mailing Address
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Address Line | PO BOX 3082
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City | REDWOOD CITY
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State | CA
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Zip | 94064-3082
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Country | US
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Telephone | 650-454-6109
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Fax | 650-231-2633
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Authorized Official
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Title or Position | MARRIAGE AND FAMILY THERAPIST
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Name | MRS. LA TANYA ALICIA TAKLA
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Credential | LMFT
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Telephone | 650-454-6109
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 49566
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License Number State | CA
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