Provider Demographics
NPI:1508096967
Name:TAYLOR, KIMBERLY COLEEN (LMFT 93627)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:COLEEN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LMFT 93627
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 N. PACIFIC COAST HIGHWAY
Mailing Address - Street 2:#1112
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-2667
Mailing Address - Country:US
Mailing Address - Phone:949-424-9681
Mailing Address - Fax:
Practice Address - Street 1:17011 BEACH BLVD STE 900
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-5998
Practice Address - Country:US
Practice Address - Phone:949-424-9681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA93627106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist