Provider Demographics
NPI:1194854786
Name:TAYLOR, JEFF A (LCSW)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:A
Last Name:TAYLOR
Suffix:
Gender:M
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:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-0031
Mailing Address - Country:US
Mailing Address - Phone:541-924-9616
Mailing Address - Fax:541-812-8807
Practice Address - Street 1:2730 WAVERLY BLVD SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-3816
Practice Address - Country:US
Practice Address - Phone:541-924-9616
Practice Address - Fax:541-812-8807
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 1041C0700X, 106H00000X
OR1490101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR197749Medicaid
OROOOOWCGKJMedicare ID - Type UnspecifiedMENTAL HEALTH