Provider Demographics
NPI:1619593076
Name:ROBERSON, TAYLOR ANN (MED, EDS, LPC)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ANN
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:MED, EDS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3381 STANFORD RD APT 208
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3985
Mailing Address - Country:US
Mailing Address - Phone:843-503-1630
Mailing Address - Fax:
Practice Address - Street 1:1531 RIVERSIDE AVE UNIT B
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4389
Practice Address - Country:US
Practice Address - Phone:843-503-1630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0016359101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health