Provider Demographics
NPI:1013474386
Name:BROWN, TAYLOR HANNAH
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:HANNAH
Last Name:BROWN
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 1:60566 NATOMA TRL
Mailing Address - Street 2:
Mailing Address - City:JOSHUA TREE
Mailing Address - State:CA
Mailing Address - Zip Code:92252-2831
Mailing Address - Country:US
Mailing Address - Phone:562-538-5480
Mailing Address - Fax:
Practice Address - Street 1:60566 NATOMA TRL
Practice Address - Street 2:
Practice Address - City:JOSHUA TREE
Practice Address - State:CA
Practice Address - Zip Code:92252-2831
Practice Address - Country:US
Practice Address - Phone:909-485-8244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-22
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CARBT-19-79291106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician