MEDICARE: MS. MARY ELIZABETH TAYLOR MSW. LCSW, LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	LAC #187	CO
2	1041C0700X	Clinical Social Worker	991143	CO

General Provider Information

NPI Number	:	1689626368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY ELIZABETH TAYLOR MSW. LCSW, LAC

Provider Business Mailing Address
First Line	:	5350 TOMAH DR STE 3600
Second Line	:
City	:	COLO SPGS
State	:	CO
Zip	:	80918-6991
Country	:	US
Telephone Number	:	719-251-9040
Fax Number	:

Provider Business Practice Location Address
First Line	:	5350 TOMAH DR STE 3600
Second Line	:
City	:	COLO SPGS
State	:	CO
Zip	:	80918-6991
Country	:	US
Telephone Number	:	719-251-9040
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	11/19/2019

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