Provider Demographics
NPI:1922165802
Name:WORKU, TSEGAMLAK TELEALE (MFT)
Entity Type:Individual
Prefix:
First Name:TSEGAMLAK
Middle Name:TELEALE
Last Name:WORKU
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E WALNUT ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-1452
Mailing Address - Country:US
Mailing Address - Phone:626-786-1019
Mailing Address - Fax:626-628-3638
Practice Address - Street 1:1000 E WALNUT ST
Practice Address - Street 2:SUITE 115
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1452
Practice Address - Country:US
Practice Address - Phone:626-786-1019
Practice Address - Fax:626-628-3638
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 37565106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist