Provider Demographics
NPI:1679802359
Name:TAYLOR, MARCIE LYNN
Entity Type:Individual
Prefix:
First Name:MARCIE
Middle Name:LYNN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 E FLORENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-4112
Mailing Address - Country:US
Mailing Address - Phone:520-876-5764
Mailing Address - Fax:520-876-5613
Practice Address - Street 1:413 E FLORENCE BLVD
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-4112
Practice Address - Country:US
Practice Address - Phone:520-876-5764
Practice Address - Fax:520-876-5613
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor