Provider Demographics
NPI:1326261561
Name:TAYLOR, LYNELL SEBASTIAN
Entity Type:Individual
Prefix:MR
First Name:LYNELL
Middle Name:SEBASTIAN
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7080 N MARKS AVE STE 104
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-0288
Mailing Address - Country:US
Mailing Address - Phone:559-248-8550
Mailing Address - Fax:
Practice Address - Street 1:7475 N PALM AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-5763
Practice Address - Country:US
Practice Address - Phone:559-439-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor