Provider Demographics
NPI:1770640922
Name:TAYLOR, SYLVIA GRACE (MFT)
Entity Type:Individual
Prefix:MS
First Name:SYLVIA
Middle Name:GRACE
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 1:1911 COMMERCENTER E
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3454
Mailing Address - Country:US
Mailing Address - Phone:909-890-2336
Mailing Address - Fax:909-890-0896
Practice Address - Street 1:1911 COMMERCENTER E
Practice Address - Street 2:SUITE 107
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3454
Practice Address - Country:US
Practice Address - Phone:909-890-2336
Practice Address - Fax:909-890-0896
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC00032193101YM0800X
CAMFC32193106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health