Provider Demographics
NPI:1770065757
Name:TAYLOR, RYAN MYCHAL (AMFT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:MYCHAL
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14537 FLORITA RD
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-4412
Mailing Address - Country:US
Mailing Address - Phone:714-872-9458
Mailing Address - Fax:
Practice Address - Street 1:14537 FLORITA RD
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-4412
Practice Address - Country:US
Practice Address - Phone:714-872-9458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA148630106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist