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General NPI Number Information
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NPI Number | 1619899648
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Entity Type | Organization
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Legal Business Name | ADJUSTED CROWN PSYCHOLOGICAL SERVICE INC
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Dates
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Enumeration Date | 07/29/2026
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Last Update Date | 07/29/2026
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Provider Practice Location Address
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Address Line | 1343 MAGNOLIA AVE
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City | MODESTO
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State | CA
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Zip | 95350-5249
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Country | US
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Telephone | 916-642-9522
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Fax | 916-234-5056
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Provider Business Mailing Address
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Address Line | 1343 MAGNOLIA AVE
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City | MODESTO
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State | CA
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Zip | 95350-5249
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Country | US
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Telephone | 916-642-9522
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Fax | 916-234-5056
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. LA TANYA ALICIA TAKLA
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Credential | EDD
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Telephone | 916-642-9522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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