Healthcare Provider Details

I. General information

NPI: 1174294847
Provider Name (Legal Business Name): TAYLOR ANNE NORRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAYLOR ANNE DIETZ

II. Dates (important events)

Enumeration Date: 09/23/2021
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1382 BLUE OAKS BLVD STE 213
ROSEVILLE CA
95678-7052
US

IV. Provider business mailing address

4932 LONG BRANCH AVE
SAN DIEGO CA
92107-2116
US

V. Phone/Fax

Practice location:
  • Phone: 877-412-8031
  • Fax:
Mailing address:
  • Phone: 916-812-7978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number156804
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: