Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | ||
N | 101YP2500X | Professional Counselor | 5004 | CA |
NPI | 1003271842 |
---|---|
Provider Name | Michelle Taylor |
First Address | Lakewood, CA 90712-2228 |
Second Address | Lakewood, CA 90712-2228 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2015 |
Last Update Date | 01/12/2020 |