MEDICARE: SANTANA TAYLOR

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	CP60904300	WA
2	101YM0800X	Mental Health Counselor	LH60957328	WA

General Provider Information

NPI Number	:	1881181063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANTANA TAYLOR

Provider Business Mailing Address
First Line	:	2205 BRECKENRIDGE DR
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66047-2318
Country	:	US
Telephone Number	:	316-204-4903
Fax Number	:

Provider Business Practice Location Address
First Line	:	307 N OLYMPIC AVE STE 231
Second Line	:
City	:	ARLINGTON
State	:	WA
Zip	:	98223-1322
Country	:	US
Telephone Number	:	360-488-1188
Fax Number	:

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

Provider Enumeration Date	:	04/13/2018
Last Update Date	:	03/26/2023

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