Provider Demographics
NPI:1093581613
Name:TAYLOR, CAMMIE CREEL (LCSW)
Entity Type:Individual
Prefix:
First Name:CAMMIE
Middle Name:CREEL
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 HERMAN LN
Mailing Address - Street 2:
Mailing Address - City:BALL
Mailing Address - State:LA
Mailing Address - Zip Code:71405-9458
Mailing Address - Country:US
Mailing Address - Phone:318-277-6535
Mailing Address - Fax:
Practice Address - Street 1:9249 S BROADWAY STE 200-206
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-5690
Practice Address - Country:US
Practice Address - Phone:318-277-6535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA714051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty