Provider Demographics
NPI:1922775063
Name:TAYLOR, TIANA ALEXANDRIA
Entity Type:Individual
Prefix:MS
First Name:TIANA
Middle Name:ALEXANDRIA
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6236 S ROCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-5745
Mailing Address - Country:US
Mailing Address - Phone:480-434-2777
Mailing Address - Fax:
Practice Address - Street 1:11542 E SHEPPERD AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-4218
Practice Address - Country:US
Practice Address - Phone:480-434-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool