Provider Demographics
NPI:1801029434
Name:TAYLOR, MARK (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19501 E MAINSTREET
Mailing Address - Street 2:STE 200
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-7408
Mailing Address - Country:US
Mailing Address - Phone:720-281-8615
Mailing Address - Fax:720-222-5168
Practice Address - Street 1:19501 E MAINSTREET STE 200
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-7408
Practice Address - Country:US
Practice Address - Phone:720-281-8615
Practice Address - Fax:720-222-5168
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-31
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
VA09040084181041C0700X
COCSW.099257771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker