=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922648518
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDA COLE-TAYLOR PHD, LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2020
-----------------------------------------------------
Last Update Date | 10/13/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 27611 LA PAZ RD STE A6
-----------------------------------------------------
City | LAGUNA NIGUEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92677-3999
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-484-8281
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 301 CAZADOR LN UNIT C
-----------------------------------------------------
City | SAN CLEMENTE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92672-6610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-484-8281
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 91662
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------