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General NPI Number Information
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NPI Number | 1376665919
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Entity Type | Individual
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Provider Name | RAELEEN ELISE TAYLOR BA
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Gender | Female
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 05/07/2021
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Provider Practice Location Address
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Address Line | 333 S BEAUDRY AVE
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City | LOS ANGELES
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State | CA
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Zip | 90017-1466
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Country | US
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Telephone | 213-741-3841
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Fax | 213-241-3305
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Provider Business Mailing Address
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Address Line | 5868 BRENTWOOD ST
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City | LOS ANGELES
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State | CA
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Zip | 90003-1118
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Country | US
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Telephone | 323-232-6527
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 94124
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License Number State | CA
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