Provider Demographics
NPI:1700250602
Name:TAYLOR, DANA (LCSW)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 RIVERWOODS TRL
Mailing Address - Street 2:
Mailing Address - City:STE GENEVIEVE
Mailing Address - State:MO
Mailing Address - Zip Code:63670-2001
Mailing Address - Country:US
Mailing Address - Phone:573-517-3119
Mailing Address - Fax:
Practice Address - Street 1:807 COLLINS DR
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-2346
Practice Address - Country:US
Practice Address - Phone:636-931-4206
Practice Address - Fax:636-931-5774
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-16
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015022650104100000X
MO20170424101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker