Provider Demographics
NPI:1265091649
Name:CERVANTES ANHEUSER, TAYLOR (RBT)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:CERVANTES ANHEUSER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:ANHEUSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6845 CAMPUS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3107
Mailing Address - Country:US
Mailing Address - Phone:719-822-0900
Mailing Address - Fax:
Practice Address - Street 1:6197 LEHMAN DR
Practice Address - Street 2:SUITE 102
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3437
Practice Address - Country:US
Practice Address - Phone:303-989-8169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician