Provider Demographics
NPI:1326352469
Name:TAYLOR, JONATHAN COLLINS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:COLLINS
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 1:1325 N MAIN ST STE 3
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-6090
Mailing Address - Country:US
Mailing Address - Phone:801-648-9021
Mailing Address - Fax:801-335-4783
Practice Address - Street 1:1325 N MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-6090
Practice Address - Country:US
Practice Address - Phone:801-648-9021
Practice Address - Fax:801-335-4783
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8033286-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical