Provider Demographics
NPI:1477956670
Name:PLASCENCIA, TANIA (MFT REGISTERED INTER)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:PLASCENCIA
Suffix:
Gender:F
Credentials:MFT REGISTERED INTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1029
Mailing Address - Country:US
Mailing Address - Phone:323-754-2662
Mailing Address - Fax:323-225-5672
Practice Address - Street 1:1200 N STATE ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1029
Practice Address - Country:US
Practice Address - Phone:323-754-2662
Practice Address - Fax:323-225-5672
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225400000X
CA89897106H00000X
CA129767106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner