Provider Demographics
NPI:1033886106
Name:NICHOLS, TAYLOR SHAELYNN
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:SHAELYNN
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11525 CHANDLER BLVD # 306
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-2618
Mailing Address - Country:US
Mailing Address - Phone:860-877-5689
Mailing Address - Fax:
Practice Address - Street 1:9744 WILSHIRE BLVD STE 309
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-1813
Practice Address - Country:US
Practice Address - Phone:855-410-3688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician