Provider Demographics
NPI:1467526384
Name:RACY, TALISHA LANETTE (MFT)
Entity Type:Individual
Prefix:MISS
First Name:TALISHA
Middle Name:LANETTE
Last Name:RACY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 ALAMEDA DE LAS PULGAS STE 240
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-1222
Mailing Address - Country:US
Mailing Address - Phone:650-573-3615
Mailing Address - Fax:
Practice Address - Street 1:1950 ALAMEDA DE LAS PULGAS STE 240
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1222
Practice Address - Country:US
Practice Address - Phone:510-427-8347
Practice Address - Fax:510-573-3615
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41875106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist