Provider Demographics
NPI:1659049542
Name:GONZALES, TAYLOR BEAU NOELLE
Entity Type:Individual
Prefix:
First Name:TAYLOR BEAU
Middle Name:NOELLE
Last Name:GONZALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45335 SIERRA HWY
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-1611
Mailing Address - Country:US
Mailing Address - Phone:661-949-8599
Mailing Address - Fax:661-723-3179
Practice Address - Street 1:45335 SIERRA HWY
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-1611
Practice Address - Country:US
Practice Address - Phone:661-949-8599
Practice Address - Fax:661-723-3179
Is Sole Proprietor?:No
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)