Provider Demographics
NPI:1396586756
Name:ELEVATED AND EMPOWERED MENTAL HEALTH, MARRIAGE AND FAMILY THERAPY, PRO
Entity type:Organization
Organization Name:ELEVATED AND EMPOWERED MENTAL HEALTH, MARRIAGE AND FAMILY THERAPY, PRO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHAYLALE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:661-235-5101
Mailing Address - Street 1:440 N BARRANCA AVE STE 4551
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-1722
Mailing Address - Country:US
Mailing Address - Phone:661-235-5101
Mailing Address - Fax:
Practice Address - Street 1:1206 W AVENUE J STE 200B
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2955
Practice Address - Country:US
Practice Address - Phone:661-235-5101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-01
Last Update Date:2024-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty