Healthcare Provider Details

I. General information

NPI: 1518895622
Provider Name (Legal Business Name): TAYLOR TYCE-GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12925 YUKON AVE
HAWTHORNE CA
90250-5421
US

IV. Provider business mailing address

1720 N FULLER AVE APT 547
LOS ANGELES CA
90046-3078
US

V. Phone/Fax

Practice location:
  • Phone: 310-644-9216
  • Fax:
Mailing address:
  • Phone: 240-481-7955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: