Healthcare Provider Details

I. General information

NPI: 1801486048
Provider Name (Legal Business Name): TAYLORMADE COUNSELING & CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2021
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36330 HIDDEN SPRINGS RD # E6
WILDOMAR CA
92595-5803
US

IV. Provider business mailing address

36330 HIDDEN SPRINGS RD STE E
WILDOMAR CA
92595-5804
US

V. Phone/Fax

Practice location:
  • Phone: 951-500-7636
  • Fax:
Mailing address:
  • Phone: 951-500-7636
  • Fax: 951-848-9916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DEBRA TAYLOR
Title or Position: OFFICE ADMIN/BILLING
Credential:
Phone: 951-500-7636