Basic Information
| Provider Information | |||||||||
| NPI: | 1184767832 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAKEUCHI | ||||||||
| FirstName: | AGUEDA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2351 CARDINAL LN | ||||||||
| Address2: | ANNEX B | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921233743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585732227 | ||||||||
| FaxNumber: | 8584962113 | ||||||||
| Practice Location | |||||||||
| Address1: | 2351 CARDINAL LN | ||||||||
| Address2: | ANNEX B | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921233743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585732227 | ||||||||
| FaxNumber: | 8584962113 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2007 | ||||||||
| LastUpdateDate: | 01/11/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC 51648 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.