Provider Demographics
NPI:1831319607
Name:TAYLOR, ERNIE CARL
Entity Type:Individual
Prefix:
First Name:ERNIE
Middle Name:CARL
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 1:1392 W STATE RD
Mailing Address - Street 2:SUITE 145
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-5020
Mailing Address - Country:US
Mailing Address - Phone:801-787-8291
Mailing Address - Fax:
Practice Address - Street 1:1392 W STATE RD
Practice Address - Street 2:SUITE 145
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062
Practice Address - Country:US
Practice Address - Phone:801-787-8291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT134827-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical