| La Tanya Takla, Psychologist Inc | |
|
1343 Magnolia Ave Modesto CA 95350-5249 | |
| (916) 642-9522 | |
| (916) 234-5056 |
| Full Name | La Tanya Takla, Psychologist Inc |
|---|---|
| Speciality | Psychologist |
| Location | 1343 Magnolia Ave, Modesto, 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 |
|---|---|
| La Tanya Takla, Psychologist Inc 1343 Magnolia Ave Modesto CA 95350-5249 Ph: (916) 642-9522 | La Tanya Takla, Psychologist Inc 1343 Magnolia Ave Modesto CA 95350-5249 Ph: (916) 642-9522 |
| NPI Number | 1336819564 |
|---|---|
| Provider Enumeration Date | 09/19/2021 |
| Last Update Date | 06/16/2026 |
| Certification Date | 06/16/2026 |
| Medicare PECOS PAC ID | 4789062290 |
|---|---|
| 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 |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417678152 PECOS PAC ID: 3779946314 Enrollment ID: I20230829003445 |
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