Healthcare Provider Details

I. General information

NPI: 1700592045
Provider Name (Legal Business Name): JEFFREY MATTHEW TAYLOR ASW139634
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2023
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 EUREKA WAY STE 101
REDDING CA
96001-0251
US

IV. Provider business mailing address

2750 EUREKA WAY STE 101
REDDING CA
96001-0251
US

V. Phone/Fax

Practice location:
  • Phone: 530-224-5469
  • Fax:
Mailing address:
  • Phone: 530-224-5469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number139634
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: