Healthcare Provider Details

I. General information

NPI: 1467213611
Provider Name (Legal Business Name): FAITH TAYLOR APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2024
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 E SHAW AVE STE 109
FRESNO CA
93710-7903
US

IV. Provider business mailing address

5665 N FRESNO ST APT 114
FRESNO CA
93710-6050
US

V. Phone/Fax

Practice location:
  • Phone: 559-712-8800
  • Fax:
Mailing address:
  • Phone: 209-777-1495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberNOLICENSE
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: