Provider Demographics
NPI:1376744706
Name:SIMONDS TAYLOR, AMY L (LPC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:SIMONDS TAYLOR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:SIMONDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3100 CHANNEL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-7837
Mailing Address - Country:US
Mailing Address - Phone:907-523-6531
Mailing Address - Fax:
Practice Address - Street 1:10815 BLACK BEAR RD
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-8783
Practice Address - Country:US
Practice Address - Phone:907-523-6531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC2242101YP2500X
AK150624101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1717306Medicaid
AK150624OtherSTATE OF ALASKA