Provider Demographics
NPI:1215539028
Name:TAYLOR, JOSELYN AMANDA
Entity Type:Individual
Prefix:
First Name:JOSELYN
Middle Name:AMANDA
Last Name:TAYLOR
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 1:1147 GEORGE WAY
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-2103
Mailing Address - Country:US
Mailing Address - Phone:928-257-2668
Mailing Address - Fax:
Practice Address - Street 1:1147 GEORGE WAY
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-2103
Practice Address - Country:US
Practice Address - Phone:928-257-2668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician