Healthcare Provider Details

I. General information

NPI: 1710096342
Provider Name (Legal Business Name): NANCY JANE TAYLOR MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12183 LOCKSLEY LN STE 101
AUBURN CA
95602-2050
US

IV. Provider business mailing address

12183 LOCKSLEY LN STE 101
AUBURN CA
95602-2050
US

V. Phone/Fax

Practice location:
  • Phone: 530-205-5271
  • Fax:
Mailing address:
  • Phone: 530-205-5271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT 45605
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: