=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023236585
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TAYLOR CONSULTING PSYCHOLOGICAL & INVESTIGATIVE SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 419 MAIN ST #358
-----------------------------------------------------
City | HUNTINGTON BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92648-5199
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-969-5100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 419 MAIN ST #358
-----------------------------------------------------
City | HUNTINGTON BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92648-5199
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-969-5100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MICHELLE TAYLOR
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 714-969-5100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PSY21358
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------