Healthcare Provider Details

I. General information

NPI: 1174430789
Provider Name (Legal Business Name): KEITH DENNIS-TAYLOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3240 E UNION HILLS DR. SUITE 107 PHOENIX, AZ 85050
PHOENIX AZ
85040
US

IV. Provider business mailing address

4950 E VAN BUREN ST APT 256
PHOENIX AZ
85008-7047
US

V. Phone/Fax

Practice location:
  • Phone: 623-715-6315
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLMSW-08379T
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: