Provider Demographics
NPI:1922577030
Name:TAUNTON, BOBBY LEE III (CADC-II, ICADC)
Entity Type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:LEE
Last Name:TAUNTON
Suffix:III
Gender:M
Credentials:CADC-II, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 AARON DR
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-3811
Mailing Address - Country:US
Mailing Address - Phone:334-799-9186
Mailing Address - Fax:
Practice Address - Street 1:1539 CAROLYN CT
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-4738
Practice Address - Country:US
Practice Address - Phone:909-413-4304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA049920618101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA049920618OtherCCAPP