Provider Demographics
NPI:1760606446
Name:TAYLOR, KEITH ANTHONY
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:ANTHONY
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 SIERRA BLVD # 1
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-2900
Mailing Address - Country:US
Mailing Address - Phone:530-573-7800
Mailing Address - Fax:530-542-7041
Practice Address - Street 1:768 PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:DIAMOND SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95619-9260
Practice Address - Country:US
Practice Address - Phone:530-621-6245
Practice Address - Fax:530-542-7041
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health