Provider Demographics
NPI:1518185289
Name:TAYLOR, JOHN KEITH (SCHOOL PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:KEITH
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:SCHOOL PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6755 E JUNIPER AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-5643
Mailing Address - Country:US
Mailing Address - Phone:480-221-7328
Mailing Address - Fax:
Practice Address - Street 1:4417 N 66TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033-2712
Practice Address - Country:US
Practice Address - Phone:623-691-4518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1849257103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool