Provider Demographics
NPI:1720407802
Name:TAYLOR, SCOTT MITCHELL (LCSW)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:MITCHELL
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:LCSW
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 1509
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30077-1509
Mailing Address - Country:US
Mailing Address - Phone:770-436-9700
Mailing Address - Fax:678-736-7308
Practice Address - Street 1:11111 HOUZE RD
Practice Address - Street 2:STE 225
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5663
Practice Address - Country:US
Practice Address - Phone:770-436-9700
Practice Address - Fax:678-736-7308
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW49401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical