Provider Demographics
NPI:1255826921
Name:TAKAKJY, DENISE (MS, LPC, NCC, BSL)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:TAKAKJY
Suffix:
Gender:F
Credentials:MS, LPC, NCC, BSL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:672 MAIN ST STE 2J
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-1679
Mailing Address - Country:US
Mailing Address - Phone:484-366-7303
Mailing Address - Fax:
Practice Address - Street 1:672 MAIN ST # 2J
Practice Address - Street 2:
Practice Address - City:HARLEYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19438-1679
Practice Address - Country:US
Practice Address - Phone:484-366-7303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC010517101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional