Provider Demographics
NPI:1568176501
Name:CLIFFORDTAYLORPHDPSYCHOLOGICALSERVICESINC
Entity Type:Organization
Organization Name:CLIFFORDTAYLORPHDPSYCHOLOGICALSERVICESINC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:D
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:909-213-2542
Mailing Address - Street 1:PO BOX 1963
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-1454
Mailing Address - Country:US
Mailing Address - Phone:909-213-2542
Mailing Address - Fax:909-307-1335
Practice Address - Street 1:615 BROOKSIDE AVE STE A
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4670
Practice Address - Country:US
Practice Address - Phone:909-335-8890
Practice Address - Fax:909-307-1335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty