Provider Demographics
NPI:1457851958
Name:DEAMON, TAYLER DANIELLE (LMFT)
Entity Type:Individual
Prefix:
First Name:TAYLER
Middle Name:DANIELLE
Last Name:DEAMON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-5012
Mailing Address - Country:US
Mailing Address - Phone:949-409-5069
Mailing Address - Fax:
Practice Address - Street 1:3434 VIA LIDO STE 200
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3967
Practice Address - Country:US
Practice Address - Phone:949-409-5069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-20
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103666101YM0800X
CA120266106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health