Provider Demographics
NPI:1609288240
Name:TAYLOR, SAMUEL THOMAS LE ROY
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:THOMAS LE ROY
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8854 W. LASALLE AVE
Mailing Address - Street 2:APT 2
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227
Mailing Address - Country:US
Mailing Address - Phone:630-346-4894
Mailing Address - Fax:
Practice Address - Street 1:4500 CHERRY CREEK DRIVE S.
Practice Address - Street 2:SUIT 940
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246
Practice Address - Country:US
Practice Address - Phone:303-322-7108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker