Provider Demographics
NPI:1558541649
Name:TAYLOR, ALEXANDRA SUSANNE (LPC)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:SUSANNE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5355 WAGON MASTER DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-2255
Mailing Address - Country:US
Mailing Address - Phone:719-822-5567
Mailing Address - Fax:719-434-9519
Practice Address - Street 1:3220 N ACADEMY BLVD STE 4
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5115
Practice Address - Country:US
Practice Address - Phone:719-822-5567
Practice Address - Fax:719-434-9519
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4791101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health