Provider Demographics
NPI:1619053006
Name:TAYLOR, JEANNE MARIE (MFT)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:MARIE
Last Name:TAYLOR
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 1:23550 LYONS AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321
Mailing Address - Country:US
Mailing Address - Phone:661-284-5945
Mailing Address - Fax:661-284-7546
Practice Address - Street 1:23550 LYONS AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321
Practice Address - Country:US
Practice Address - Phone:661-284-5945
Practice Address - Fax:661-284-7546
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36618106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist