Provider Demographics
NPI:1417774563
Name:TAKU, AGENDIA (DENG)
Entity type:Individual
Prefix:
First Name:AGENDIA
Middle Name:
Last Name:TAKU
Suffix:
Gender:F
Credentials:DENG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8631 CEDARDALE PARK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-1555
Mailing Address - Country:US
Mailing Address - Phone:520-891-0513
Mailing Address - Fax:
Practice Address - Street 1:8631 CEDARDALE PARK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-1555
Practice Address - Country:US
Practice Address - Phone:520-891-0513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician