Healthcare Provider Details

I. General information

NPI: 1265669923
Provider Name (Legal Business Name): MARCELLE BONNEAU TAYLOR MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2009
Last Update Date: 12/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 W. VALENCIA MESA EMMANUEL EPISCOPAL CHURCH
FULLERTON CA
92833
US

IV. Provider business mailing address

1477 FRANCIS AVE.
UPLAND CA
91786
US

V. Phone/Fax

Practice location:
  • Phone: 909-985-8092
  • Fax: 909-985-8092
Mailing address:
  • Phone: 909-985-8092
  • Fax: 909-985-8092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberML17129
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: