Provider Demographics
NPI:1932710449
Name:TAYLOR, NICHELLE
Entity type:Individual
Prefix:
First Name:NICHELLE
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6004 J STREET
Mailing Address - Street 2:RHC SUTTER HALL
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3414
Mailing Address - Country:US
Mailing Address - Phone:407-508-9115
Mailing Address - Fax:
Practice Address - Street 1:1830 SIERRA GARDENS DR STE 10
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2942
Practice Address - Country:US
Practice Address - Phone:407-508-9115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health