Provider Demographics
NPI:1275256281
Name:TAYLOR, CRAIG (MSW)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16340 NE 83RD ST APT A102
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3879
Mailing Address - Country:US
Mailing Address - Phone:619-405-1821
Mailing Address - Fax:
Practice Address - Street 1:8301 161ST AVENUE NORTHWEST
Practice Address - Street 2:SUITE 202
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052
Practice Address - Country:US
Practice Address - Phone:142-599-6859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61352966101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty