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General NPI Number Information
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NPI Number | 1629726328
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Entity Type | Organization
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Legal Business Name | THERAPY LINK, LICENSED CLINICAL SOCIAL WORKER, INC.
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Dates
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Enumeration Date | 03/13/2022
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Last Update Date | 03/13/2022
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Provider Practice Location Address
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Address Line | 14011 LODGEPOLE CT
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City | PENN VALLEY
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State | CA
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Zip | 95946-9128
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Country | US
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Telephone | 916-599-5524
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Fax |
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Provider Business Mailing Address
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Address Line | 11354 PLEASANT VALLEY RD # 94
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City | PENN VALLEY
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State | CA
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Zip | 95946-9000
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Country | US
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Telephone | 916-407-0047
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Fax |
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Authorized Official
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Title or Position | CEO/MANAGER
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Name | ALYSA HARLESS JOHNSON
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Credential | LCSW
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Telephone | 916-407-0047
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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