Provider Demographics
NPI:1457826570
Name:TAYLOR, AMBER L
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:L
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:AMBER
Other - Middle Name:L
Other - Last Name:SKELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2546 S REDWOOD RD APT 3
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-2219
Mailing Address - Country:US
Mailing Address - Phone:435-830-2091
Mailing Address - Fax:
Practice Address - Street 1:2546 S REDWOOD RD APT 3
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-2219
Practice Address - Country:US
Practice Address - Phone:435-830-2091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTRBT-18-65996106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician