Provider Demographics
NPI:1558819920
Name:VARGAS, TAYLOR LYNN (MS)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:LYNN
Last Name:VARGAS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 N SUTTER ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-2412
Mailing Address - Country:US
Mailing Address - Phone:209-851-3460
Mailing Address - Fax:
Practice Address - Street 1:127 N SUTTER ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-2412
Practice Address - Country:US
Practice Address - Phone:209-851-3460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health