Provider Demographics
NPI:1932540085
Name:TAYLOR, KIMBERLY JILL (MS, MFT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:JILL
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8440 W LAKE MEAD BLVD
Mailing Address - Street 2:206
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-7648
Mailing Address - Country:US
Mailing Address - Phone:702-355-4407
Mailing Address - Fax:
Practice Address - Street 1:8440 W LAKE MEAD BLVD
Practice Address - Street 2:206
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-7648
Practice Address - Country:US
Practice Address - Phone:702-355-4407
Practice Address - Fax:702-242-4429
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1013569903106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist