Provider Demographics
NPI:1457087256
Name:TAYLOR, CLIFTON RAY JR
Entity Type:Individual
Prefix:MR
First Name:CLIFTON
Middle Name:RAY
Last Name:TAYLOR
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1871 E ST DAVID CT
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-6447
Mailing Address - Country:US
Mailing Address - Phone:520-208-0648
Mailing Address - Fax:
Practice Address - Street 1:1470 E AVENIDA ISABELA
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-1035
Practice Address - Country:US
Practice Address - Phone:520-560-7111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker