Provider Demographics
NPI:1265799951
Name:LA TANYA TAKLA
Entity type:Organization
Organization Name:LA TANYA TAKLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LA TANYA
Authorized Official - Middle Name:ALICIA
Authorized Official - Last Name:TAKLA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:650-454-6109
Mailing Address - Street 1:PO BOX 3082
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94064-3082
Mailing Address - Country:US
Mailing Address - Phone:650-454-6109
Mailing Address - Fax:650-231-2633
Practice Address - Street 1:1652 W TEXAS ST
Practice Address - Street 2:SUITE 131
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6066
Practice Address - Country:US
Practice Address - Phone:650-454-6109
Practice Address - Fax:650-231-2633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49566106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty