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General NPI Number Information
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NPI Number | 1396586756
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Entity Type | Organization
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Legal Business Name | ELEVATED AND EMPOWERED MENTAL HEALTH, MARRIAGE AND FAMILY THERAPY, PRO
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Dates
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Enumeration Date | 06/01/2024
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Last Update Date | 06/01/2024
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Provider Practice Location Address
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Address Line | 1206 W AVENUE J STE 200B
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City | LANCASTER
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State | CA
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Zip | 93534-2955
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Country | US
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Telephone | 661-235-5101
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Fax |
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Provider Business Mailing Address
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Address Line | 440 N BARRANCA AVE STE 4551
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City | COVINA
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State | CA
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Zip | 91723-1722
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Country | US
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Telephone | 661-235-5101
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SHAYLALE TAYLOR
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Credential | LMFT
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Telephone | 661-235-5101
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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