Provider Demographics
NPI:1518335561
Name:PICKETT, TARYN NICOLE (MFT)
Entity Type:Individual
Prefix:
First Name:TARYN
Middle Name:NICOLE
Last Name:PICKETT
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 S ESPLANADE ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-5353
Mailing Address - Country:US
Mailing Address - Phone:714-396-9362
Mailing Address - Fax:
Practice Address - Street 1:3001 RED HILL AVE STE 221
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4529
Practice Address - Country:US
Practice Address - Phone:714-396-9362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-08
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78031106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist