Basic Information
| Provider Information | |||||||||
| NPI: | 1013121557 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | MONA | ||||||||
| MiddleName: | LEE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16707 GARFIELD AVE SPC 1406 | ||||||||
| Address2: | |||||||||
| City: | PARAMOUNT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907237630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629297188 | ||||||||
| FaxNumber: | 5629297575 | ||||||||
| Practice Location | |||||||||
| Address1: | 11902 ROSECRANS AVE | ||||||||
| Address2: | |||||||||
| City: | NORWALK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906504197 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629297188 | ||||||||
| FaxNumber: | 5629297575 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.