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NPI Code Detail

MEDICARE: MRS. TAYLOR MARIE TICA MA, LPCC

MEDICARE: MRS. TAYLOR MARIE TICA MA, LPCC
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
1101YM0800XMental Health Counselor
2101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1912436205
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TAYLOR MARIE TICA MA, LPCC
Provider Business Mailing Address
First Line : 8880 RIO SAN DIEGO DR STE 800
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-1642
Country : US
Telephone Number : 760-557-5572
Fax Number :
Provider Business Practice Location Address
First Line : 8880 RIO SAN DIEGO DR STE 800
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-1642
Country : US
Telephone Number : 760-557-5572
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2017
Last Update Date : 09/24/2025

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