Provider Demographics
NPI:1184950610
Name:TAYLOR, CHARLES DAVID (MFT, PHD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:DAVID
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MFT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 E YANONALI ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-1855
Mailing Address - Country:US
Mailing Address - Phone:805-895-3054
Mailing Address - Fax:805-966-7756
Practice Address - Street 1:222 E YANONALI ST UNIT A
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-1855
Practice Address - Country:US
Practice Address - Phone:805-895-3054
Practice Address - Fax:805-966-7756
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-17
Last Update Date:2009-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC43679106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist