Provider Demographics
NPI:1770216699
Name:TACHKOV, BRITTANY OLISAR
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:OLISAR
Last Name:TACHKOV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2128 ALEXANDER WAY
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-8308
Mailing Address - Country:US
Mailing Address - Phone:630-989-1145
Mailing Address - Fax:
Practice Address - Street 1:4133 MOHR AVE STE I
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-4750
Practice Address - Country:US
Practice Address - Phone:925-236-0042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-07
Last Update Date:2024-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
11672225A00000X
CALMFT145479106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist