Provider Demographics
NPI:1508148271
Name:TAYLOR, OMAR D (RC)
Entity Type:Individual
Prefix:MR
First Name:OMAR
Middle Name:D
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:RC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12350 W 18TH DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-2515
Mailing Address - Country:US
Mailing Address - Phone:303-241-3689
Mailing Address - Fax:
Practice Address - Street 1:1450 S ASH ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-3629
Practice Address - Country:US
Practice Address - Phone:303-377-2586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health