Provider Demographics
NPI:1184366718
Name:BARSTAD, TAYLOR MAUREEN (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MAUREEN
Last Name:BARSTAD
Suffix:
Gender:F
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 1:625 E STASSNEY LN APT 3304
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-4268
Mailing Address - Country:US
Mailing Address - Phone:307-689-6314
Mailing Address - Fax:
Practice Address - Street 1:13341 W HWY 290 STE 1-105
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78737-9160
Practice Address - Country:US
Practice Address - Phone:512-640-2559
Practice Address - Fax:844-674-1637
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106907104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX106907OtherPRIVATE PAY