Provider Demographics
NPI:1629726328
Name:THERAPY LINK, LICENSED CLINICAL SOCIAL WORKER, INC.
Entity Type:Organization
Organization Name:THERAPY LINK, LICENSED CLINICAL SOCIAL WORKER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALYSA
Authorized Official - Middle Name:HARLESS
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:916-407-0047
Mailing Address - Street 1:11354 PLEASANT VALLEY RD # 94
Mailing Address - Street 2:
Mailing Address - City:PENN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95946-9000
Mailing Address - Country:US
Mailing Address - Phone:916-407-0047
Mailing Address - Fax:
Practice Address - Street 1:14011 LODGEPOLE CT
Practice Address - Street 2:
Practice Address - City:PENN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95946-9128
Practice Address - Country:US
Practice Address - Phone:916-599-5524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-13
Last Update Date:2022-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty