Provider Demographics
NPI:1760204424
Name:CERNY, TAYLOR LANE (AMFT)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:LANE
Last Name:CERNY
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:MRS
Other - First Name:TAYLOR
Other - Middle Name:LANE
Other - Last Name:CLANCY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AMFT
Mailing Address - Street 1:444 S ROXBURY DR APT A
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4114
Mailing Address - Country:US
Mailing Address - Phone:650-784-3681
Mailing Address - Fax:
Practice Address - Street 1:1849 SAWTELLE BLVD STE 620
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7013
Practice Address - Country:US
Practice Address - Phone:424-268-2762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA148843106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist