Provider Demographics
NPI:1053613406
Name:BESSIRE-TAYLOR, NICOLE ROSE (MA, LMFT)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ROSE
Last Name:BESSIRE-TAYLOR
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 N GLENDORA AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-6924
Mailing Address - Country:US
Mailing Address - Phone:909-618-4355
Mailing Address - Fax:
Practice Address - Street 1:216 N GLENDORA AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-6924
Practice Address - Country:US
Practice Address - Phone:909-618-4355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46572106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist