Provider Demographics
NPI:1134582299
Name:SMITH, TAYLOR FOSTER (PHD)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:FOSTER
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 MARSH ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2957
Mailing Address - Country:US
Mailing Address - Phone:805-242-6462
Mailing Address - Fax:844-733-9350
Practice Address - Street 1:1411 MARSH ST
Practice Address - Street 2:SUITE 106
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2957
Practice Address - Country:US
Practice Address - Phone:805-242-6462
Practice Address - Fax:844-733-9350
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28183103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent