Provider Demographics
NPI:1720881295
Name:TAKODA THERAPIES
Entity type:Organization
Organization Name:TAKODA THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:CTRS
Authorized Official - Phone:512-983-6015
Mailing Address - Street 1:17028 JOHN MICHAEL DR
Mailing Address - Street 2:
Mailing Address - City:MANOR
Mailing Address - State:TX
Mailing Address - Zip Code:78653-3393
Mailing Address - Country:US
Mailing Address - Phone:512-983-6015
Mailing Address - Fax:
Practice Address - Street 1:17028 JOHN MICHAEL DR
Practice Address - Street 2:
Practice Address - City:MANOR
Practice Address - State:TX
Practice Address - Zip Code:78653-3393
Practice Address - Country:US
Practice Address - Phone:512-983-6015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAMP FIONA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorGroup - Multi-Specialty