Provider Demographics
NPI:1083231856
Name:TAYLOR, AMBER (LAC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21640 N 19TH AVE STE C9
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-2720
Mailing Address - Country:US
Mailing Address - Phone:602-499-9952
Mailing Address - Fax:
Practice Address - Street 1:21640 N 19TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-2720
Practice Address - Country:US
Practice Address - Phone:602-402-4340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-28
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-17146101YP2500X
101YM0800X
AZLPC-19292101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional