Provider Demographics
NPI:1033636840
Name:GARRIS, TAYLOR
Entity Type:Individual
Prefix:PROF
First Name:TAYLOR
Middle Name:
Last Name:GARRIS
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:P.O BOX 52131
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82605
Mailing Address - Country:US
Mailing Address - Phone:307-258-9890
Mailing Address - Fax:
Practice Address - Street 1:1810 HYVIEW DR APT 3
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-3466
Practice Address - Country:US
Practice Address - Phone:307-258-9890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool