Provider Demographics
NPI:1821635541
Name:TAYLOR, MAURICE CHARLES (MA)
Entity Type:Individual
Prefix:MR
First Name:MAURICE
Middle Name:CHARLES
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2765
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94966-2765
Mailing Address - Country:US
Mailing Address - Phone:415-246-6490
Mailing Address - Fax:
Practice Address - Street 1:3030 BRIDGEWAY STE 226
Practice Address - Street 2:
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-3813
Practice Address - Country:US
Practice Address - Phone:415-246-6490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-01
Last Update Date:2019-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40564106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist