Individual ProviderGloria Elysia TakedaMarriage & Family TherapistBehavioral Health & Social Service ProvidersPractice Address4990 Williams Ave, La Mesa, CA 91942-7409(619) 668-4200PECOS EnrollmentBased on the most recent information from CMS, provider Gloria Elysia Takeda does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1417472226Provider TypeIndividualFull NameTakeda, Gloria ElysiaCredentialMFTIGenderFemaleSole ProprietorYesEnumeration Date8/14/2017Last Updated1/6/2021Contact InformationPractice LocationPractice Address4990 Williams Ave, La Mesa, CA 91942-7409Phone(619) 668-4200FaxUnlisted FaxMailing LocationMailing Address4990 Williams Ave, La Mesa, CA 91942-7409Phone(619) 668-4200FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode106H00000XPrimaryDescriptionMarriage & Family TherapistBehavioral Health & Social Service ProvidersLicenseUnlisted IssuerCalifornia