Provider Demographics
NPI:1821332032
Name:TAYLOR, PAUL-ROY (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL-ROY
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 N BARRANCA AVE # 1104
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-1722
Mailing Address - Country:US
Mailing Address - Phone:323-366-8067
Mailing Address - Fax:323-488-9291
Practice Address - Street 1:468 N CAMDEN DRIVE
Practice Address - Street 2:STE 200 PMB 91245
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4507
Practice Address - Country:US
Practice Address - Phone:323-366-8067
Practice Address - Fax:323-488-9291
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-12
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29563103TA0400X, 103TC0700X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01261511Medicaid