Provider Demographics
NPI:1861948275
Name:TAYLOR, TRAVIS R (MS LMFT)
Entity type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:R
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MS LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13530 AMANDA DR
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-4782
Mailing Address - Country:US
Mailing Address - Phone:909-816-9417
Mailing Address - Fax:
Practice Address - Street 1:13530 AMANDA DR
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-4782
Practice Address - Country:US
Practice Address - Phone:949-415-8728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-27
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88555106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist