Provider Demographics
NPI:1114408192
Name:PECCHENINO, TAYLOR NICOLE (LMFT)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:NICOLE
Last Name:PECCHENINO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:NICOLE
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1925 SPRING ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-1619
Mailing Address - Country:US
Mailing Address - Phone:805-721-1812
Mailing Address - Fax:
Practice Address - Street 1:1925 SPRING ST UNIT B
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-1619
Practice Address - Country:US
Practice Address - Phone:805-721-1812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA117988106H00000X
CA129164106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program