Provider Demographics
NPI:1013121557
Name:TAYLOR, MONA LEE
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:LEE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16707 GARFIELD AVE SPC 1406
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-7630
Mailing Address - Country:US
Mailing Address - Phone:562-929-7188
Mailing Address - Fax:562-929-7575
Practice Address - Street 1:11902 ROSECRANS AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-4197
Practice Address - Country:US
Practice Address - Phone:562-929-7188
Practice Address - Fax:562-929-7575
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)