Provider Demographics
NPI:1831691351
Name:TAYLOR, REESE ELLEN (LPCC)
Entity type:Individual
Prefix:
First Name:REESE
Middle Name:ELLEN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 CORDOVA PL # 804
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-1725
Mailing Address - Country:US
Mailing Address - Phone:505-699-7885
Mailing Address - Fax:
Practice Address - Street 1:1334 AGUA FRIA ST
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-3576
Practice Address - Country:US
Practice Address - Phone:505-699-7885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-28
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0089091101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM0089091OtherLPCC