Provider Demographics
NPI:1881386092
Name:PATHWAYS TO MENDING FEELINGS PSYCHOTHERAPY TRAINING PROGRAM INC
Entity type:Organization
Organization Name:PATHWAYS TO MENDING FEELINGS PSYCHOTHERAPY TRAINING PROGRAM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LA TANYA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TAKLA
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:916-642-9522
Mailing Address - Street 1:1343 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-5249
Mailing Address - Country:US
Mailing Address - Phone:916-642-9522
Mailing Address - Fax:916-642-9522
Practice Address - Street 1:1651 RESPONSE RD STE 111
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-5254
Practice Address - Country:US
Practice Address - Phone:916-642-9522
Practice Address - Fax:916-678-4138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty