MEDICARE: PSYCHLES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1205546876
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCHLES, INC.

Provider Business Mailing Address
First Line	:	55 SANTA CLARA AVE STE 165
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94610-1333
Country	:	US
Telephone Number	:	510-239-3745
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 SANTA CLARA AVE STE 165
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94610-1333
Country	:	US
Telephone Number	:	510-239-3745
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST/CEO
Name	:	LATOYA R BRAXTON
Credential	:	LMFT
Telephone Number	:	510-289-1042

Provider Enumeration Date	:	12/05/2022
Last Update Date	:	12/05/2022

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Directions to “PSYCHLES, INC. ” Practice Location

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