Provider Demographics
NPI:1235401373
Name:TAYLOR, MELANIE R (LPC, LAC)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:R
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 ELM DR
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81503-2907
Mailing Address - Country:US
Mailing Address - Phone:970-985-9379
Mailing Address - Fax:970-241-3342
Practice Address - Street 1:516 28 RD STE D
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-6537
Practice Address - Country:US
Practice Address - Phone:970-985-9379
Practice Address - Fax:970-241-3342
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-06
Last Update Date:2015-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3570101YP2500X
CO0000387101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11584128OtherCAQH
CO55285082Medicaid