Provider Demographics
NPI:1477891828
Name:DICKINSON, TAYLOR ANN (IMF)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ANN
Last Name:DICKINSON
Suffix:
Gender:F
Credentials:IMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22471 ASPAN ST STE 103
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-1644
Mailing Address - Country:US
Mailing Address - Phone:949-458-2715
Mailing Address - Fax:949-458-3583
Practice Address - Street 1:22471 ASPAN ST STE 103
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1644
Practice Address - Country:US
Practice Address - Phone:949-458-2715
Practice Address - Fax:949-458-3583
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73919101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health