Provider Demographics
NPI:1942655634
Name:NADEAU, TALIA JEAN (LMFT)
Entity Type:Individual
Prefix:
First Name:TALIA
Middle Name:JEAN
Last Name:NADEAU
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:TALIA
Other - Middle Name:JEAN
Other - Last Name:HOFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT 124500
Mailing Address - Street 1:PO BOX 2808
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437
Mailing Address - Country:US
Mailing Address - Phone:915-745-5929
Mailing Address - Fax:
Practice Address - Street 1:327 E. REDWOOD AVE, SUITE 331-D
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437
Practice Address - Country:US
Practice Address - Phone:707-813-2104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-29
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86103106H00000X
CALMFT124500106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist