Provider Demographics
NPI:1578036547
Name:TAYLOR, BONI LEE (LCSW)
Entity Type:Individual
Prefix:
First Name:BONI
Middle Name:LEE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 N CARBONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-3902
Mailing Address - Country:US
Mailing Address - Phone:435-630-5086
Mailing Address - Fax:
Practice Address - Street 1:445 NORTH CARBONVILLE ROAD
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501
Practice Address - Country:US
Practice Address - Phone:435-650-6447
Practice Address - Fax:801-538-4016
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT294216-3502101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor