Provider Demographics
NPI:1043752181
Name:MADSEN, TAYLOR (LMFT)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:MADSEN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:489 W 1400 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-7000
Mailing Address - Country:US
Mailing Address - Phone:385-448-0310
Mailing Address - Fax:
Practice Address - Street 1:489 W 1400 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-7000
Practice Address - Country:US
Practice Address - Phone:801-885-7970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-07
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9132078-3904106H00000X
UT9132078-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist