Provider Demographics
NPI:1659431401
Name:TAYLOR, JOHN ROBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 682077
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84068-2077
Mailing Address - Country:US
Mailing Address - Phone:435-647-2911
Mailing Address - Fax:
Practice Address - Street 1:136 HEBER AVE.
Practice Address - Street 2:SUITE 204
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84068
Practice Address - Country:US
Practice Address - Phone:435-647-2911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT114801-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical