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General NPI Number Information
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NPI Number | 1477337525
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Entity Type | Individual
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Provider Name | TAKAKO UDELL LPCC
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Gender | Female
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Dates
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Enumeration Date | 08/21/2023
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 2300 BOSWELL RD STE 112
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City | CHULA VISTA
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State | CA
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Zip | 91914-3523
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Country | US
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Telephone | 619-549-0329
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 BOSWELL RD STE 112
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City | CHULA VISTA
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State | CA
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Zip | 91914-3523
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 14054
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License Number State | CA
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