Provider Demographics
NPI:1467240572
Name:TAYLOR, STACEY ROCHELLE
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:ROCHELLE
Last Name:TAYLOR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3204 VILLA PISANI CT
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-7267
Mailing Address - Country:US
Mailing Address - Phone:214-283-0024
Mailing Address - Fax:
Practice Address - Street 1:3204 VILLA PISANI CT
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-7267
Practice Address - Country:US
Practice Address - Phone:214-283-0024
Practice Address - Fax:214-283-0024
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV225C00000X225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor