Provider Demographics
NPI:1265122014
Name:TAYLOR, CALOB
Entity type:Individual
Prefix:
First Name:CALOB
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 S GREELEY HWY STE B
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007-3063
Mailing Address - Country:US
Mailing Address - Phone:970-372-1146
Mailing Address - Fax:970-223-8219
Practice Address - Street 1:1217 S GREELEY HWY STE B
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82007-3063
Practice Address - Country:US
Practice Address - Phone:307-202-4005
Practice Address - Fax:307-448-4708
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPCSW-10831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical