Provider Demographics
NPI:1649418799
Name:TAYLOR, NICOLAS TODD (PHD, CAC III)
Entity Type:Individual
Prefix:
First Name:NICOLAS
Middle Name:TODD
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PHD, CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 W MAIN ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-3349
Mailing Address - Country:US
Mailing Address - Phone:970-249-4448
Mailing Address - Fax:970-249-4449
Practice Address - Street 1:242 W MAIN ST
Practice Address - Street 2:SUITE 9
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-3349
Practice Address - Country:US
Practice Address - Phone:970-249-4448
Practice Address - Fax:970-249-4449
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-28
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2546103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist