Provider Demographics
NPI:1851019889
Name:TAYLOR, JESSICA LARAE (MFT TRAINEE)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LARAE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MFT TRAINEE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 HARRISON WAY
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-7907
Mailing Address - Country:US
Mailing Address - Phone:949-899-2497
Mailing Address - Fax:
Practice Address - Street 1:17350 MOUNT HERRMANN ST STE A
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4114
Practice Address - Country:US
Practice Address - Phone:949-899-2497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist