Provider Demographics
NPI:1790779338
Name:TAYLOR, JENNIFER F (PH D)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:F
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:799 H ST # 239
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-6240
Mailing Address - Country:US
Mailing Address - Phone:707-826-9601
Mailing Address - Fax:
Practice Address - Street 1:1433 11TH ST # F
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-5712
Practice Address - Country:US
Practice Address - Phone:707-826-9601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18047103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL180470OtherBLUE SHIELD PIN
CAOPL180470Medicare PIN