Healthcare Provider Details

I. General information

NPI: 1326261561
Provider Name (Legal Business Name): MR. LYNELL SEBASTIAN TAYLOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 06/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7475 N PALM AVE SUITE 107
FRESNO CA
93711-5763
US

IV. Provider business mailing address

7080 N MARKS AVE STE 104 SUITE 104
FRESNO CA
93711-0288
US

V. Phone/Fax

Practice location:
  • Phone: 559-439-5437
  • Fax:
Mailing address:
  • Phone: 559-248-8550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: