Provider Demographics
NPI:1972620078
Name:TAYLOR, DERYL (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:DERYL
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10030 VIA PESCADERO
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-2746
Mailing Address - Country:US
Mailing Address - Phone:951-385-5013
Mailing Address - Fax:951-485-1959
Practice Address - Street 1:1012 E COOLEY DR STE B
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3959
Practice Address - Country:US
Practice Address - Phone:951-570-7823
Practice Address - Fax:888-356-9214
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19190106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty