Provider Demographics
NPI:1881427706
Name:WOLF, TAYLOR (CADC-INTERN, BA, AAS)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:WOLF
Suffix:
Gender:F
Credentials:CADC-INTERN, BA, AAS
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CADC-INTERN, AAS
Mailing Address - Street 1:6750 CAJON LN
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-7611
Mailing Address - Country:US
Mailing Address - Phone:775-513-2958
Mailing Address - Fax:
Practice Address - Street 1:1161 S LOOP RD BLDG B
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-4765
Practice Address - Country:US
Practice Address - Phone:775-751-6990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV02656-I101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)