Provider Demographics
NPI:1811646813
Name:TAYLOR, SCOTT MICHEAL (LCSW)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:MICHEAL
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 N CHARLEY DR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-4329
Mailing Address - Country:US
Mailing Address - Phone:907-759-7447
Mailing Address - Fax:201-474-0468
Practice Address - Street 1:1981 E PALMER WASILLA HWY STE 235
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7289
Practice Address - Country:US
Practice Address - Phone:907-759-7447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-18
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2188241041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical