Provider Demographics
NPI:1265669923
Name:TAYLOR, MARCELLE BONNEAU (MFT)
Entity Type:Individual
Prefix:MRS
First Name:MARCELLE
Middle Name:BONNEAU
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1477 FRANCIS AVE.
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786
Mailing Address - Country:US
Mailing Address - Phone:909-985-8092
Mailing Address - Fax:909-985-8092
Practice Address - Street 1:1145 W. VALENCIA MESA
Practice Address - Street 2:EMMANUEL EPISCOPAL CHURCH
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833
Practice Address - Country:US
Practice Address - Phone:909-985-8092
Practice Address - Fax:909-985-8092
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-19
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAML17129106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist