MEDICARE: MS. HEATHER ELYSE TAYLOR MFT 44021

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC44021	CA

General Provider Information

NPI Number	:	1265514251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HEATHER ELYSE TAYLOR MFT 44021

Provider Business Mailing Address
First Line	:	1141 LEVER BLVD
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95206-2855
Country	:	US
Telephone Number	:	209-986-5368
Fax Number	:	209-547-1287

Provider Business Practice Location Address
First Line	:	5420 FRED RUSSO DR
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95212-2862
Country	:	US
Telephone Number	:	209-933-7350
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	06/13/2024

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