Provider Demographics
NPI:1871678821
Name:TAYLOR, MELVIN (LISAC)
Entity Type:Individual
Prefix:MR
First Name:MELVIN
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:LISAC
Other - Prefix:
Other - First Name:MELVIN
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:288 N IRONWOOD DR STE 110
Mailing Address - Street 2:SAN TAN COUNSELING
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85220-3830
Mailing Address - Country:US
Mailing Address - Phone:480-982-2356
Mailing Address - Fax:480-982-0859
Practice Address - Street 1:288 N IRONWOOD DR STE 110
Practice Address - Street 2:SAN TAN COUNSELING
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85220-3830
Practice Address - Country:US
Practice Address - Phone:480-982-2356
Practice Address - Fax:480-982-0859
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1229101Y00000X
AZ10612101YM0800X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health