Healthcare Provider Details

I. General information

NPI: 1114408192
Provider Name (Legal Business Name): TAYLOR NICOLE PECCHENINO LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAYLOR NICOLE PHILLIPS

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 SPRING ST UNIT B
PASO ROBLES CA
93446-1619
US

IV. Provider business mailing address

1925 SPRING ST UNIT B
PASO ROBLES CA
93446-1619
US

V. Phone/Fax

Practice location:
  • Phone: 805-721-1812
  • Fax:
Mailing address:
  • Phone: 805-721-1812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number117988
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number129164
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: