Healthcare Provider Details

I. General information

NPI: 1790779338
Provider Name (Legal Business Name): JENNIFER F. TAYLOR PH. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1433 11TH ST # F
ARCATA CA
95521-5712
US

IV. Provider business mailing address

799 H ST # 239
ARCATA CA
95521-6240
US

V. Phone/Fax

Practice location:
  • Phone: 707-826-9601
  • Fax:
Mailing address:
  • Phone: 707-826-9601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY18047
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: