Provider Demographics
NPI:1619527850
Name:TAYLOR COUNSELING SERVICES TAYLOR TLC
Entity Type:Organization
Organization Name:TAYLOR COUNSELING SERVICES TAYLOR TLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LISAC
Authorized Official - Phone:928-460-0593
Mailing Address - Street 1:1000 AINSWORTH DR STE B215
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-3411
Mailing Address - Country:US
Mailing Address - Phone:928-445-0744
Mailing Address - Fax:928-445-0537
Practice Address - Street 1:1000 AINSWORTH DR STE B215
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-3411
Practice Address - Country:US
Practice Address - Phone:928-445-0744
Practice Address - Fax:928-445-0537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty