Provider Demographics
NPI:1790446839
Name:TAYLOR, MARCHELL DERONNE
Entity Type:Individual
Prefix:
First Name:MARCHELL
Middle Name:DERONNE
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 1:1882 E 104TH AVE UNIT 528
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-4327
Mailing Address - Country:US
Mailing Address - Phone:720-490-9834
Mailing Address - Fax:
Practice Address - Street 1:4141 E DICKENSON PL
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-6012
Practice Address - Country:US
Practice Address - Phone:303-504-6500
Practice Address - Fax:303-757-5245
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional