Provider Demographics
NPI:1720262991
Name:LAMONT T BROWN TAYLOR
Entity Type:Organization
Organization Name:LAMONT T BROWN TAYLOR
Other - Org Name:FULL ADVOCATE BHS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSE CLINICAL SOCIAL WORKER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAMONT
Authorized Official - Middle Name:THEOLONUS
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DSW
Authorized Official - Phone:773-509-5055
Mailing Address - Street 1:PO BOX 490645
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-0645
Mailing Address - Country:US
Mailing Address - Phone:773-509-5055
Mailing Address - Fax:773-509-5010
Practice Address - Street 1:10540 S WESTERN AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-2529
Practice Address - Country:US
Practice Address - Phone:773-509-5055
Practice Address - Fax:773-509-5010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-011481101Y00000X, 101YM0800X, 104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty