Mending Feelings | |
1651 Response Rd Ste 111 Sacramento CA 95815-5254 | |
(916) 642-9522 | |
(916) 678-4138 |
Full Name | Mending Feelings |
---|---|
Speciality | Psychologist |
Location | 1651 Response Rd Ste 111, Sacramento, California |
Authorized Official Name and Position | La Tanya Alicia Takla (OWNER/LICENSE CLINICAL PSYCHOLOGIST) |
Authorized Official Contact | 9166429522 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Mending Feelings 1343 Magnolia Ave Modesto CA 95350-5249 Ph: (916) 642-9522 | Mending Feelings 1651 Response Rd Ste 111 Sacramento CA 95815-5254 Ph: (916) 642-9522 |
NPI Number | 1336819564 |
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Provider Enumeration Date | 09/19/2021 |
Last Update Date | 08/15/2022 |
Certification Date | 08/15/2022 |
Medicare PECOS PAC ID | 4789062290 |
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Medicare Enrollment ID | O20220610002029 |
Identifier | Type | State | Issuer |
---|---|---|---|
1336819564 | NPI | - | NPPES |
100224781 | Medicaid | CA | |
CA460451 | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
261QC1800X | Clinic/center - Corporate Health | (* (Not Available)) | Secondary |
Provider Name | La Tanya Alicia Takla |
---|---|
Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1366635526 PECOS PAC ID: 1951586262 Enrollment ID: I20210412000928 |
Provider Name | Angelique D York |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1417678152 PECOS PAC ID: 3779946314 Enrollment ID: I20230829003445 |
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