Provider Demographics
NPI:1588040802
Name:TAYLOR, JAMULA EMMALETTE (LMFT)
Entity Type:Individual
Prefix:
First Name:JAMULA
Middle Name:EMMALETTE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 HAAS AVE APT 311
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-3779
Mailing Address - Country:US
Mailing Address - Phone:510-506-4887
Mailing Address - Fax:
Practice Address - Street 1:202 E AIRPORT DR STE 265
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3444
Practice Address - Country:US
Practice Address - Phone:909-939-5007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA129183106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program