Provider Demographics
NPI:1619182334
Name:TAYLOR, SHAJUANA A (MFTI)
Entity Type:Individual
Prefix:MRS
First Name:SHAJUANA
Middle Name:A
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1058 TERMINO AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-4126
Mailing Address - Country:US
Mailing Address - Phone:562-506-3116
Mailing Address - Fax:
Practice Address - Street 1:1161 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3023
Practice Address - Country:US
Practice Address - Phone:562-506-3116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74104106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist