Healthcare Provider Details

I. General information

NPI: 1417484312
Provider Name (Legal Business Name): PATRICIA WANSLEY TAYLOR, LMFT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2204 S EL CAMINO REAL STE 205
OCEANSIDE CA
92054-6389
US

IV. Provider business mailing address

2204 S EL CAMINO REAL STE 205
OCEANSIDE CA
92054-6389
US

V. Phone/Fax

Practice location:
  • Phone: 760-585-5680
  • Fax: 844-373-1890
Mailing address:
  • Phone: 760-585-5680
  • Fax: 844-373-1890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number85355
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number85355
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number85355
License Number StateCA

VIII. Authorized Official

Name: PATRICIA TAYLOR
Title or Position: LFMT
Credential:
Phone: 760-585-5680