Healthcare Provider Details

I. General information

NPI: 1285846840
Provider Name (Legal Business Name): PEGGY SUE TAYLOR PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 03/19/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 S COLVIN ST.
COLORADO CITY AZ
86021
US

IV. Provider business mailing address

PO BOX 418
COLORADO CITY AZ
86021-0418
US

V. Phone/Fax

Practice location:
  • Phone: 435-900-1104
  • Fax:
Mailing address:
  • Phone: 435-900-1104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5335545-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: