Provider Demographics
NPI:1346527496
Name:CLEMENT, TAYLOR WOODS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:TAYLOR
Middle Name:WOODS
Last Name:CLEMENT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:TY
Other - Middle Name:
Other - Last Name:CLEMENT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:2235 E SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-2623
Mailing Address - Country:US
Mailing Address - Phone:406-241-1863
Mailing Address - Fax:
Practice Address - Street 1:2235 E SUMMIT DR
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59803-2623
Practice Address - Country:US
Practice Address - Phone:406-241-1863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical