Healthcare Provider Details

I. General information

NPI: 1548433097
Provider Name (Legal Business Name): AFFINITY COUNSELING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2008
Last Update Date: 04/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11110 LOS ALAMITOS BLVD STE. 202
LOS ALAMITOS CA
90720-3602
US

IV. Provider business mailing address

11110 LOS ALAMITOS BLVD STE. 202
LOS ALAMITOS CA
90720-3602
US

V. Phone/Fax

Practice location:
  • Phone: 714-330-9627
  • Fax:
Mailing address:
  • Phone: 714-330-9627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY18674
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. NICOLE L. TAYLOR
Title or Position: PSYCHOLOGIST
Credential: PSY.D
Phone: 714-330-9627