Provider Demographics
NPI:1326515164
Name:TAYLOR, SUSAN J (LMFT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:J
Other - Last Name:MERRITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:955 CASTLEWOOD DR APT 3
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1321
Mailing Address - Country:US
Mailing Address - Phone:408-313-5614
Mailing Address - Fax:
Practice Address - Street 1:15495 LOS GATOS BLVD STE 5
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2544
Practice Address - Country:US
Practice Address - Phone:408-679-2160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94361106H00000X
CA114162106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist