Basic Information
| Provider Information | |||||||||
| NPI: | 1932348109 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAKESHIMA | ||||||||
| FirstName: | PHILICIA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | M.ED., BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 170 ARLENE DR | ||||||||
| Address2: | |||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945951754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9253246372 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3650 MT DIABLO BLVD STE 107 | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945493780 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5106659700 | ||||||||
| FaxNumber: | 5106659400 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2009 | ||||||||
| LastUpdateDate: | 12/26/2018 | ||||||||
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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 | 103K00000X | CA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.