Provider Demographics
NPI:1023103926
Name:TAYLOR, JARED M (LCSW)
Entity type:Individual
Prefix:MR
First Name:JARED
Middle Name:M
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 557
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84326-0557
Mailing Address - Country:US
Mailing Address - Phone:435-752-5302
Mailing Address - Fax:435-753-9007
Practice Address - Street 1:175 W 1400 N
Practice Address - Street 2:SUITE A
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-6811
Practice Address - Country:US
Practice Address - Phone:435-752-5302
Practice Address - Fax:435-753-9007
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTLCSW 6201971-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical