Provider Demographics
NPI:1003154980
Name:TAYLOR, DAISY BERNICE (MA)
Entity Type:Individual
Prefix:MRS
First Name:DAISY
Middle Name:BERNICE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 FALCON DR
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-5869
Mailing Address - Country:US
Mailing Address - Phone:530-867-0278
Mailing Address - Fax:
Practice Address - Street 1:433 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3758
Practice Address - Country:US
Practice Address - Phone:530-867-0278
Practice Address - Fax:530-661-3819
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPC 198101YM0800X
FLMH 10185101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health